All Men with Vasculogenic Erectile Dysfunction Require a Cardiovascular Workup

Miner, Martin; Nehra, Ajay; Jackson, Graham; Bhasin, Shalender; Billups, Kevin L.; Burnett, Arthur L.; Buvat, J.; Carson, Culley C.; Cunningham, Glenn R.; Ganz, Patricia A.; Goldstein, Irwin; Guay, André T.; Hackett, Geoff; Kloner, Robert A.; Kostis, John B.; Laflamme, Karina; Montorsi, Piero; Ramsey, Melinda; Rosen, Raymond C.; Sadovsky, Richard; Seftel, Allen D.; Shabsigh, Ridwan; Vlachopoulos, Charalambos; Wu, Frederick C. W.

doi:10.1016/j.amjmed.2013.10.013

Cited by 78 publications

(68 citation statements)

References 64 publications

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“…Only in diabetic and cardiovascular highrisk patients (Framingham Risk Score), an ABI of < 0.9 may be associated with and be predictive for ED [23]. In line, cardiovascular risk stratifi cation in patients with suspected ED using the Framingham Risk Score is promoted by some in order to determine the diagnostic work-up [24].…”

Section: Clinical Examinationmentioning

confidence: 99%

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Erectile dysfunction – overview from a cardiovascular perspective

Baumann¹,

Hehli

Makaloski

et al. 2017

Vasa

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Summary:Erectile dysfunction (ED) is an evolving health problem with growing incidence in the ageing male population with potentially predictive value for cardiovascular and other chronic diseases. ED shares the common cardiovascular risk factors. The aetiology of ED is numerous including neurogenic, psychogenic, arteriogenic, and venogenic reasons. The origin of arteriogenic ED is frequently atherosclerosis. Patients not adequately responding to conservative measures including oral medication are often referred to further vascular diagnostics and therapy. At present, the refi nements in endovascular therapy allow for minimal-invasive revascularization of erection-related arteries. The role of endovascular therapy in the complex framework of the multifactorial causes of ED requires further scientifi c scrutiny.

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Section: Clinical Examinationmentioning

confidence: 99%

“…In addition, a glucose and lipid profi le testing is recommended. Of note, testing of testosterone levels is particularly recommended in patients with failed PDE-5 inhibitor treatment [24]. Testosterone levels < 200 ng/dl are considered low and supplementation may be considered [25].…”

Section: Laboratory Testingmentioning

confidence: 99%

Erectile dysfunction – overview from a cardiovascular perspective

Baumann¹,

Hehli

Makaloski

et al. 2017

Vasa

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“…[8] The absence of CAC is conclusive of minimal to no risk of ASCVD in the following 10-years. The presence of CAC may help guide the clinician regarding appropriate primary prevention therapy and certainly is one of the strongest discriminatory tests for the intermediate risk patient in CVD risk stratification.…”

Section: Cac Potential Role In Ed Management: Level Of Evidence = 1bmentioning

confidence: 99%

“…New guidelines have attempted to address the shortcomings of older risk models. ED guidelines such as Princeton III have attempted to utilize evidence-based evaluation to further stratify men for cardiovascular (CVS) risk following the utilization of keen history taking and traditional risk models to establish the presence of predominantly vasculogenic ED and the volume of subclinical atherosclerotic burden which are markers for subsequent CVS events of MI and CVA in men [7,8]. These guidelines are an attempt to elaborate the following questions: [9] Is a history of ED a harbinger for future cardiovascular risk?…”

Section: Introductionmentioning

confidence: 99%

The Metabolic Investigation of Erectile Dysfunction: Cardiometabolic Risk Stratification

Miner¹

2014

J Diabetes Metab

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This review discusses the latest evidence for the metabolic investigation of erectile dysfunction as it relates to cardiometabolic risk and visceral adiposity, the key component of metabolic syndrome. The authors illustrate this concept with a clinical example from their own practice, and the metabolic investigation of ED as it relates to the etiology and cardiovascular risk stratification utilizing the latest guidelines of cardiovascular risk released this past year. The authors conclude with the levels of evidence for the use of novel biomarkers in the evaluation of the patient with ED as applied to cardiometabolic risk.

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“…The European Society of Cardiology 2016 guidelines give a level IIa recommendation but with class C evidence to consider cardiovascular risk assessment in men with ED. 9 Other expert groups have proposed stress test evaluation in men with ED and intermediate risk; 10,11 however, more clinical trial evidence is Vascular Medicine 23 (1) needed before implementing cardiovascular testing in men with ED without any clinical cardiovascular symptoms.…”

mentioning

confidence: 99%

Erectile dysfunction in the trajectory of cardiovascular disease

Kluge

Hamburg

2017

Vasc Med

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/home/vmj Cardiovascular disease (CVD) remains the leading cause of death in men. Both young and older men have considerable rates of cardiovascular events. Erectile dysfunction (ED) is common, afflicting more than half of men aged 40-70 years and greater than 70% of men over age 70. Robust evidence links the presence of ED with heightened risk of cardiovascular events. 1 In a recent meta-analysis of prospective studies, men with ED had a higher relative risk of myocardial infarction, total CV events, and all-cause mortality. 2 The clinical expression of ED frequently occurs prior to coronary artery disease, suggesting that ED may serve as a marker for subclinical vascular disease. Thus, there is potential clinical utility for cardiovascular prevention in increased detection and treatment of ED.In addition to ED predicting CVD risk, vascular disease contributes to ED pathophysiology. 3 Cardiovascular risk factors predict the development of ED, suggesting a vascular component. 4 Even prior to the development of overt CVD, men with ED display evidence of vascular abnormalities. 5 The extent and type of subclinical vascular dysfunction present in ED has not been fully elaborated.In the current issue of Vascular Medicine, Osondu and colleagues report their findings from a meta-analysis of the associations of ED with subclinical CVD. 6 There were 28 cross-sectional studies that evaluated ED as identified by an established questionnaire and markers of subclinical vascular alterations: flow-mediated dilation of the brachial artery and carotid intima-media thickness by ultrasound. The authors report that men with ED have impaired flow-mediated dilation, indicating endothelial dysfunction, and greater carotid intima-media thickness, indicating early atherosclerosis. Importantly, the association of endothelial dysfunction and carotid atherosclerosis persisted when adjusting for age, supporting the idea that ED may have particular clinical utility in younger patients who may lack more traditional cardiovascular risk factors. However, in the available studies included in the metaanalysis, coronary artery calcium scoring, a marker of coronary atherosclerosis, did not show consistent associations with ED.The study findings advance our knowledge regarding the connection between ED and vascular dysfunction. The association of ED with endothelial dysfunction and early atherosclerosis provides evidence that ED may serve as a marker of early vascular disease that is easily ascertained by clinical history taking. The connection may reflect shared underlying mechanisms leading to ED and CVD. Similar pathophysiology contributes to both endothelial dysfunction and ED, including loss of nitric oxide bioavailability and increased inflammatory activation. 3 Thus, established risk-reduction therapies may have a benefit for men with low cardiovascular risk undergoing treatment for ED. 7 Interestingly, a recent nationwide Swedish cohort study of males less than 80 years old demonstrated that treatment for ED with PDE-5 inhibitors or alprost...

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All Men with Vasculogenic Erectile Dysfunction Require a Cardiovascular Workup

Cited by 78 publications

References 64 publications

Erectile dysfunction – overview from a cardiovascular perspective

Erectile dysfunction – overview from a cardiovascular perspective

The Metabolic Investigation of Erectile Dysfunction: Cardiometabolic Risk Stratification

Erectile dysfunction in the trajectory of cardiovascular disease

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