From the Guidelines
Patients with erectile dysfunction (ED) have a significantly increased risk of cardiovascular disease, and ED should be considered an early warning sign of potential cardiovascular problems. The risk is particularly high in younger men with ED (under 60 years), who have a 2-3 times higher risk of developing cardiovascular disease compared to men without ED 1. This connection exists because both conditions share common risk factors and pathophysiology, primarily endothelial dysfunction and atherosclerosis. The same vascular issues that affect penile blood vessels often affect coronary and other arteries throughout the body, but symptoms appear earlier in the smaller penile vessels. Common risk factors include:
- Hypertension
- Diabetes
- Dyslipidemia
- Obesity
- Smoking
- Sedentary lifestyle For this reason, patients presenting with ED should undergo comprehensive cardiovascular risk assessment, including:
- Blood pressure measurement
- Lipid profile
- Blood glucose testing
- Evaluation of other cardiovascular risk factors Lifestyle modifications such as regular exercise, smoking cessation, weight management, and a heart-healthy diet are recommended for all ED patients to reduce cardiovascular risk 1. In many cases, treating the underlying cardiovascular risk factors may also improve erectile function. The Princeton Consensus Panel recommends assigning patients to one of three risk levels (high, intermediate, and low) based on their cardiovascular risk factors, and patients at high risk should not receive treatment for sexual dysfunction until their cardiac condition has stabilized 1. Therefore, it is essential to assess and manage cardiovascular risk factors in patients with ED to reduce the risk of cardiovascular disease and improve overall health outcomes.
From the Research
Cardiovascular Risk in Patients with Erectile Dysfunction (ED)
The relationship between erectile dysfunction (ED) and cardiovascular disease (CVD) is well-established, with ED often serving as a warning signal for potential cardiovascular events 2. Several studies have investigated the association between ED and CVD, highlighting the importance of considering cardiovascular risk factors in patients with ED.
Prevalence of Cardiovascular Disease in Patients with ED
- The prevalence of ED is estimated to be around 50% in patients with coronary heart disease 3.
- ED can be an independent risk factor for future cardiovascular events in patients without pre-existing cardiovascular disease 3, 4.
- Vascular disease is the most common cause of ED, and the symptoms of ED often precede those of cardiovascular events by 3 to 5 years 2, 4.
Risk Factors Associated with ED and CVD
- Common risk factors for ED and CVD include increasing age, depression, obesity, lack of exercise, diabetes mellitus, hypertension, dyslipidaemia, and lower urinary tract symptoms related to benign prostatic hyperplasia 5.
- The evaluation of men with ED requires a comprehensive medical and sexual history, a focused clinical examination, and laboratory tests such as fasting glucose levels and lipid profiles 5.
Diagnostic Work-up and Treatment Options
- Diagnostic work-up in ED includes a cardiovascular screening, although the real benefit of this recommendation is unclear 3.
- Treatment options for ED include lifestyle modification, reduction of comorbid vascular risk factors, and pharmacotherapy with phosphodiesterase type 5 inhibitors (PDE5i) or other agents 5, 4.
- Early identification of ED could allow for optimal management of patients to reduce the risk of cardiovascular events 4, 6.
Cardiovascular Risk Stratification and Management
- Vascular erectile dysfunction is a powerful marker of increased cardiovascular risk, and current guidelines lack specific recommendations on its role in cardiovascular risk assessment 6.
- The use of personalized prognostic tools, such as the coronary artery calcium score, may aid in cardiovascular risk stratification and management of men with vascular erectile dysfunction 6.