Cardiovascular risk stratification and cardiovascular risk factors associated with erectile dysfunction: Assessing cardiovascular risk in men with erectile dysfunction

Abstract

Summary: Cardiovascular risk factors are known to be associated with the presence of erectile dysfunction (ED), and ED is more common in men with cardiovascular disease (CVD). The Princeton Guidelines provide a strategy for assessing cardiac risk and planning a safe return to sexual activity. Men at low risk, who have fewer than three cardiac risk factors, can resume intercourse with very little concern for an untoward cardiac event. Men at high risk need to have their primary disease controlled, and should be stabilized before planning to resume sexual activity. Prior to resuming intercourse, men in the indeterminate category are candidates for restratification as either low or high risk. Certain cardiovascular risk factors may be predictors of ED: most notably, hyperlipidemia, hypertension, and diabetes. Advancing age is also a strong predictor of ED. The close correlation between ED and CVD is a signal to evaluate the sexual histories of all men who present for cardiovascular evaluation and, perhaps, of all men in general. Early detection of ED may allow for early diagnosis and management of CVD and diabetes.

Reactive oxygen species and erectile dysfunction: possible role of NADPH oxidase

“…Principal among these risk factors are DM, hypercholesterolaemia (HcH), dyslipidaemia, cigarette smoking, hypertension and possibly HHC. [2][3][4][5][6] This association points to a common aetiology in both scenarios.…”

“…The treatment of ED has also taken on new importance in that ED is a predictor of more serious CVDs. [4][5][6] It follows, also, that those therapies that prove successful in preventing in ED may prevent longer term CVDs that include atherogenesis, myocardial infarction and stroke.…”

“…1 It has also become increasingly apparent that ED is indicative of underlying vasculopathy and represents a predictor of more serious cardiovascular disorders. [2][3][4][5][6] Understanding the aetiology of ED may therefore provide invaluable pointers to the pathobiology of other cardiovascular diseases (CVDs) and related syndromes. It follows, too, that therapeutic interventions that are successful in treating ED may, ipso facto, be effective in treating the early stages of CVDs including atherosclerosis, angina, plaque rupture, hypertension and diabetic angiopathy.…”

Sexual dysfunction in the elderly: age or disease?

“…Smoking, obesity, hypertension, diabetes and dyslipidemias contribute to ED in elderly men. 20,23,45 Although vascular comorbidities are associated with ED, a study using neural computational networks identified SHIM scores representing moderate ED correlated with age, total testosterone and a depression scale. 46 Testosterone declines with age in men at a rate of 1-2% a year.…”

Should an inquiry about sexual health, as a reflection of vascular health, be part of routine physicals for young men? Results from an outpatient study

“…ED may act as a marker for silent coronary artery disease and may therefore precede a coronary event; this concept is reinforced by ED and vascular disease sharing the same risk factors. [18][19][20][21][22] In August 2003, the MHI (Minority Health Institute) convened an Expert Advisory Panel of cardiologists and urologists to design a new practice model algorithm that uses ED as a clinical tool for the early identification of men with systemic vascular disease. The MHI algorithm noted ED as a marker for the presence of cardiovascular disease and suggested that ED may well be a cardiovascular risk equivalent warranting aggressive secondary prevention management strategies, even in the absence of other cardiac or peripheral vascular symptoms.…”