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Determining the Prognostic Implications of Erectile Dysfunction for Future Cardiovascular Disease with Noninvasive Testing

  • MEDICAL COMORBIDITIES (AT GOLDSTEIN, M MINER, AND SJ PARISH, SECTION EDITORS)
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Abstract

Available data make a strong argument for the role of erectile dysfunction (ED) as an early marker of cardiovascular disease. Patients with coronary artery disease very often have ED, and, importantly, patients presenting with ED as their initial condition have an increased prevalence of silent coronary artery disease. Most importantly, ED is an independent predictor of future cardiovascular events. Therefore, assessment and management of ED may play an important role in identifying and reducing the risk for cardiovascular events. Cardiovascular risk assessment using conventional risk factor algorithms is important for initial risk stratification. Risk is further evaluated via determination of presence or absence of additional cardiovascular risk factors and exercise stress testing. Additionally, a growing body of evidence supports the use of a number of easily measured vascular or circulating biomarkers to further characterize risk for cardiovascular events in men with ED, but few have been evaluated in this population.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Seftel AD, Sun P, Swindle R. The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol. 2004;171(6 Pt 1):2341–5.

    Article  PubMed  Google Scholar 

  2. Grover SA, Lowensteyn I, Kaouache M, Marchand S, Coupal L, DeCarolis E, et al. The prevalence of erectile dysfunction in the primary care setting: importance of risk factors for diabetes and vascular disease. Arch Intern Med. 2006;166:213–9.

    Article  PubMed  Google Scholar 

  3. Montorsi P, Ravagnani PM, Galli S, Salonia A, Briganti A, Werba JP, et al. Association between erectile dysfunction and coronary artery disease: matching the right target with the right test in the right patient. Eur Urol. 2006;50:721–31.

    Article  PubMed  Google Scholar 

  4. Vlachopoulos C, Rokkas K, Ioakeimidis N, et al. Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study. Eur Urol. 2005;48:996–1002.

    Article  PubMed  Google Scholar 

  5. Vlachopoulos CV, Terentes Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes. 2013;6(1):99–109. A systematic review and meta-analysis of all longitudinal studies for determining the ability of ED to predict risk of clinical events and to dissect factors influencing this ability.

    Article  PubMed  Google Scholar 

  6. Perk J, De Backer G, Gohlke H, European Association for Cardiovascular Prevention & Rehabilitation (EACPR), ESC Committee for Practice Guidelines (CPG), et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33(13):1635–701.

    Article  CAS  PubMed  Google Scholar 

  7. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47.

    Article  CAS  PubMed  Google Scholar 

  8. Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010;122(25):e584–636.

    Article  PubMed  Google Scholar 

  9. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949–3003.

    Article  PubMed  Google Scholar 

  10. Montorsi P, Ravagnani PM, Galli S, et al. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J. 2006;22:2632–9.

    Article  Google Scholar 

  11. Vlachopoulos C, Ioakeimidis N, Terentes-Printzios D, Stefanadis C. The triad: erectile dysfunction–endothelial dysfunction–cardiovascular disease. Curr Pharm Des. 2008;14:3700–14.

    Article  CAS  PubMed  Google Scholar 

  12. Montorsi P, Montorsi F, Schulman CC. Is erectile dysfunction the “tip of the iceberg” of a systemic vascular disorder? Eur Urol. 2003;44(3):352–4.

    Article  PubMed  Google Scholar 

  13. Enbergs A, Burger R, Reinecke H, Borggrefe M, Breithardt G, Kerber S. Prevalence of coronary artery disease in a general population without suspicion of coronary artery disease: angiographic analysis of subjects aged 40 to 70 years referred for catheter ablation therapy. Eur Heart J. 2000;21:45–52.

    Article  CAS  PubMed  Google Scholar 

  14. Araujo AB, Hall SA, Ganz P, Chiu GR, Rosen RC, Kupelian V, et al. Does erectile dysfunction contribute to cardiovascular disease risk prediction beyond the Framingham risk score? J Am Coll Cardiol. 2010;55(4):350–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Bohm M, Baumhakel M, Teo K, Sleight P, Probstfield J, Gao P, et al. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) trials. Circulation. 2010;121(12):1439–46.

    Article  PubMed  Google Scholar 

  16. Gazzaruso C, Solerte SB, Pujia A, Coppola A, Vezzoli M, Salvucci F, et al. Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with angiographically proven asymptomatic coronary artery disease: a potential protective role for statins and 5-phosphodiesterase inhibitors. J Am Coll Cardiol. 2008;51(21):2040–4.

    Article  PubMed  Google Scholar 

  17. Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294:2996–3002.

    Article  CAS  PubMed  Google Scholar 

  18. Miner M, Seftel AD, Nehra A, Ganz P, Kloner RA, Montorsi P, et al. Prognostic utility of erectile dysfunction for cardiovascular disease in younger men and those with diabetes. Am Heart J. 2012;164:21–8. This review focuses in a practical and clinically meaningful way on cardiovascular risk detection and reduction strategies in erectile dysfunction patients <60 years old and in those with diabetes.

    Article  PubMed  Google Scholar 

  19. Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012;87:766–78. A landmark paper. The recommendations focus on (1) evaluation and management of cardiovascular risk in men with erectile dysfunction and no known cardiovascular disease, (2) reevaluation and modification of the second conference recommendations for evaluation of cardiac risk associated with sexual activity in men with known cardiovascular disease, and (3) the role of testosterone therapy in erectile dysfunction and management of cardiovascular disease.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Persu C, Cauni V, Gutue S, Albu ES, Jinga V, Geavlete P. Diagnosis and treatment of erectile dysfunction—a practical update. J Med Life. 2009;2:394–400.

    CAS  PubMed Central  PubMed  Google Scholar 

  21. Cappelleri JC, Rosen RC. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res. 2005;17:307–19.

    Article  CAS  PubMed  Google Scholar 

  22. Aversa A, Sarteschi LM. The role of penile color-duplex ultrasound for the evaluation of erectile dysfunction. J Sex Med. 2007;4(5):1437–47.

    Article  PubMed  Google Scholar 

  23. Vlachopoulos C, Jackson G, Stefanadis C, Montorsi P. Erectile dysfunction in the cardiovascular patient. Eur Heart J. 2013;34(27):2034–46. A comprehensive review of the critical connection between erectile dysfunction and cardiovascular disease. Algorithms for the management of patient with erectile dysfunction according to the risk for sexual activity and future cardiovascular events are also proposed.

    Article  PubMed  Google Scholar 

  24. Jackson G, Nehra A, Miner M, Billups KL, Burnett AL, Buvat J, et al. The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician. Int J Clin Pract. 2013;67(11):1163–72.

    Article  CAS  PubMed  Google Scholar 

  25. Gandaglia G, Briganti A, Jackson G, Kloner RA, Montorsi F, Montorsi P, Vlachopoulos C. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol. 2013 [Epub ahead of print].

  26. Dahabreh IJ, Paulus JK. Association of episodic physical and sexual activity with triggering of acute cardiac events: systematic review and meta-analysis. JAMA. 2011;305(12):1225–33.

    Article  PubMed  Google Scholar 

  27. Levine GN, Steinke EE, Bakaeen FG, Bozkurt B, Cheitlin MD, Conti JB, et al. Sexual activity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2012;125:1058–72.

    Article  PubMed  Google Scholar 

  28. Buvat J, Maggi M, Guay A, Torres LO. Testosterone deficiency in men: systematic review and standard operating procedures for diagnosis and treatment. J Sex Med. 2013;10(1):245–84. A comprehensive review for diagnosis and treatment of testosterone deficiency.

    Article  CAS  PubMed  Google Scholar 

  29. Jones TH, Saad F. The effects of testosterone on risk factors for, and the mediators of, the atherosclerotic process. Atherosclerosis. 2009;207(2):318–27.

    Article  CAS  PubMed  Google Scholar 

  30. Corona G, Rastrelli G, Monami M, Guay A, Buvat J, Sforza A, et al. Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. Eur J Endocrinol. 2011;165(5):687–701.

    Article  CAS  PubMed  Google Scholar 

  31. Welt FGP, Simon DI. Atherosclerosis and plaque rupture. Catheter Cardiovasc Interv. 2001;53:56–63.

    Article  CAS  PubMed  Google Scholar 

  32. Jackson G. Erectile dysfunction and asymptomatic coronary artery disease: frequently detected by computed tomography coronary angiography but not by exercise electrocardiography. Int J Clin Pract. 2013;67(11):1159–62.

    Article  CAS  PubMed  Google Scholar 

  33. Corona G, Monami M, Boddi V, Cameron-Smith M, Lotti F, de Vita G, et al. Male sexuality and cardiovascular risk. A cohort study in patients with erectile dysfunction. J Sex Med. 2010;7(5):1918–27.

    Article  PubMed  Google Scholar 

  34. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.

    Article  PubMed  Google Scholar 

  35. Hlatky MA, Greenland P, Arnett DK, Ballantyne CM, Criqui MH, Elkind MS, et al. Criteria for evaluation of novel markers of cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2009;119(17):2408–16.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Yeboah J, McClelland RL, Polonsky TS, Burke GL, Sibley CT, O’Leary D, et al. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA. 2012;308(8):788–95.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Perrone-Filardi P, Achenbach S, Mohlenkamp S, Achenbach S, Möhlenkamp S, Reiner Z, et al. Cardiac computed tomography and myocardial perfusion scintigraphy for risk stratification in asymptomatic individuals without known cardiovascular disease: a position statement of the Working Group on Nuclear Cardiology and Cardiac CT of the European Society of Cardiology. Eur Heart J. 2011;32(16):1986–93.

    Article  PubMed  Google Scholar 

  38. Corona G, Monami M, Boddi V, Rastrelli G, Melani C, Balzi D, et al. Pulse pressure independently predicts major cardiovascular events in younger but not in older subjects with erectile dysfunction. J Sex Med. 2011;8:247–54.

    Article  PubMed  Google Scholar 

  39. Ma RC, SoW Y, Yang X, Yu LW, Kong AP, Ko GT, et al. Erectile dysfunction predicts coronary heart disease in type 2 diabetes. J Am Coll Cardiol. 2008;51:2045–50.

    Article  PubMed  Google Scholar 

  40. Vlachopoulos C, Aznaouridis K, Ioakeimidis N, Rokkas K, Vasiliadou C, Alexopoulos N, et al. Unfavourable endothelial and inflammatory state in erectile dysfunction patients with or without coronary artery disease. Eur Heart J. 2006;27(22):2640–8.

    Article  CAS  PubMed  Google Scholar 

  41. Batty GD, Li Q, Czernichow S, Neal B, Zoungas S, Huxley R, et al. Erectile dysfunction and later cardiovascular disease in men with type 2 diabetes: prospective cohort study based on the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial. J Am Coll Cardiol. 2010;56(23):1908–13.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Gandaglia G, Salonia A, Passoni N, Montorsi P, Briganti A, Montorsi F. Erectile dysfunction as a cardiovascular risk factor in patients with diabetes. Endocrine. 2013;43(2):285–92.

    Article  CAS  PubMed  Google Scholar 

  43. Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035–87.

    Article  PubMed  Google Scholar 

  44. Manolis A, Doumas M. Sexual dysfunction: the ‘prima ballerina’ of hypertension-related quality-of-life complications. J Hypertens. 2008;26(11):2074–84.

    Article  CAS  PubMed  Google Scholar 

  45. Baumhäkel M, Schlimmer N, Kratz M, Hackett G, Jackson G, Böhm M. Cardiovascular risk, drugs and erectile function—a systematic analysis. Int J Clin Pract. 2011;65:289–98.

    Article  PubMed  Google Scholar 

  46. Viigimaa M, Doumas M, Vlachopoulos C, Anyfanti P, Wolf J, Narkiewicz K, et al. European Society of Hypertension Working Group on Sexual Dysfunction. Hypertension and sexual dysfunction: time to act. J Hypertens. 2011;29(2):403–7.

    Article  CAS  PubMed  Google Scholar 

  47. Chin D, Battistoni A, Tocci G, Passerini J, Parati G, Volpe M. Non-invasive diagnostic testing for coronary artery disease in the hypertensive patient: potential advantages of a risk estimation-based algorithm. Am J Hypertens. 2012;25(12):1226–35.

    PubMed  Google Scholar 

  48. Vlachopoulos C, Aznaouridis K, Ioakeimidis N, Rokkas K, Tsekoura D, Vasiliadou C, et al. Arterial function and intima-media thickness in hypertensive patients with erectile dysfunction. J Hypertens. 2008;26(9):1829–36.

    Article  CAS  PubMed  Google Scholar 

  49. Vlachopoulos C, Ioakeimidis N, Miner M, Aggelis A, Pietri P, Terentes-Printzios, et al. Testosterone deficiency: a determinant of aortic stiffness in men. Atherosclerosis 2014;233(1):278–83.

  50. Vlachopoulos C, Ioakeimidis N, Terentes-Printzios D, Aznaouridis K, Rokkas K, Aggelis A, et al. Plasma total testosterone and incident cardiovascular events in hypertensive patients. Am J Hypertens. 2013;26:373–8.

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

Charalambos Vlachopoulos, Nikolaos Ioakeimidis, and Christodoulos Stefanadis declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Profiti Elia 24, 14575, Athens, Greece

    Charalambos Vlachopoulos, Nikolaos Ioakeimidis & Christodoulos Stefanadis

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  1. Charalambos Vlachopoulos
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  2. Nikolaos Ioakeimidis
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  3. Christodoulos Stefanadis
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Correspondence to Charalambos Vlachopoulos.

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This article is part of the Topical Collection on Medical Comorbidities

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Vlachopoulos, C., Ioakeimidis, N. & Stefanadis, C. Determining the Prognostic Implications of Erectile Dysfunction for Future Cardiovascular Disease with Noninvasive Testing. Curr Sex Health Rep 6, 145–154 (2014). https://doi.org/10.1007/s11930-014-0020-z

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