Erectile Dysfunction is a Marker for Cardiovascular Disease: Results of the Minority Health Institute Expert Advisory Panel

Abstract

Introduction Cardiovascular disease and its related comorbidities are associated with significant morbidity and mortality and affect a disproportionately large number of African Americans and Hispanics. The prevalence of cardiovascular disease is increasing worldwide, which underscores the urgency to improve methods of prevention and early detection. Aim To develop a risk assessment and management algorithm for primary care patients with erectile dysfunction (ED) that facilitates diagnosis, early intervention, and prevention of cardiovascular disease. Methods The Minority Health Institute (MHI) convened an Expert Advisory Panel of cardiologists and urologists to design a new practice model algorithm that uses ED as a clinical tool for early identification of men with systemic vascular disease. A draft of the algorithm was presented at a national symposium and comments from symposium participants were considered in the development of the final algorithm. Main Outcome Measures and Results Erectile dysfunction is common and has long been considered a secondary complication of cardiovascular disease, diabetes, hypertension, and dyslipidemia. However, a growing body of evidence challenges this view, suggesting instead that ED is an early manifestation of atherosclerosis and a precursor to systemic vascular disease. Endothelial dysfunction is the etiologic factor linking ED and cardiovascular disease. Conclusions The recognition of ED as an early sign of systemic cardiovascular disease offers an opportunity for prevention, particularly in high-risk and underserved minority populations. The MHI algorithm stipulates that all men 25 years old and older regardless of sexual dysfunction complaints should be asked about ED. The presence of ED should prompt an aggressive assessment for cardiovascular risk and occult systemic vascular disease.

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

“…9 In addition, data from the Olmsted County Study suggest that ED is far more predictive of CAD in men 40 to 49 years of age than in older men, 24 and the incidence of atherosclerotic cardiovascular events in men younger than 40 years with ED was more than 7 times the incidence in a reference population representative of the general male population in Western Australia. 25 Thus, ED may be particularly useful in assessing cardiovascular risk in younger men 26 and in minorities, 27 whose risk may be underestimated by global risk assessments such as the FRS. Finally, assessment of ED must include ED severity because more severe ED has been associated with greater risk of major cardiovascular events, 28 CAD, 23,29 extent of CAD, 19,21,30 and risk of PAD (ACCF/AHA class Ia).…”

The effects of chronic phosphodiesterase-5 inhibitor use on different organ systems

“…The ensuing avalanche of research and interest in sexual dysfunction has been transferred this once 'private condition' from the exclusive domain of the urologist into the laps of numerous medical disciplines and demonstrated the close connection between endothelial dysfunction and ED as well as the potential signaling of ED as an early marker for cardiovascular conditions. 18 To date, PDE-5i are the most widely prescribed oral agents for ED treatment and Viagra is one of the most frequently sold drugs in the world. Specialists of all varieties are increasingly encountering patients seeking therapy for sexual dysfunction.…”

Assessment of endothelial function in the patient with erectile dysfunction: an opportunity for the urologist

“…103 Similarly, the Minority Health Institute issued an algorithm that demands aggressive assessment for overt or occult cardiovascular disease in all men with ED. 24 Montorsi et al 7 recommend additional noninvasive tests for men with intermediate cardiac risk. Going by the standardized Framingham risk score, this risk category represents almost 40% of the male US population.…”

“…21,22 However, we now know that that the underlying mechanism of pathophysiology for both ED and CAD is endothelial dysfunction. 23,24 In both cases, a deficiency of the vasorelaxing factor nitric oxide (NO) is brought about by impaired production or increased degradation by reactive oxidant species. NO is synthesized by nitric oxide synthase (NOS) from the amino acid L-arginine.…”