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The Prognostic Role of Erectile Dysfunction for Cardiovascular Events

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Erectile Dysfunction in Hypertension and Cardiovascular Disease

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Abstract

Erectile dysfunction (ED) is a universal clinical problem with thousands of new cases per year. Cardiovascular disease (CVD) and ED share common risk factors, while evidence-based studies have identified pathophysiological links, such as endothelial dysfunction, inflammation, and low testosterone, thus identifying ED as an appealing candidate marker for future events. Screening and diagnosing ED is essential for primary prevention since ED assessment offers a low-cost, easy alternative to several investigational cardiovascular biomarkers and could describe the risk over and beyond traditional risk factors, particularly for those patients belonging into the intermediate cardiovascular risk category. ED may precede clinically overt CVD by 2–5 years providing a valuable time window to earlier modification of risk factors and potentially improve outcomes. Presence of ED increases the risk for future cardiovascular events, myocardial infarction, stroke, and all-cause mortality. Evidence points towards a grading effect of the severity of ED in the predictive ability of this condition for clinical outcome. Several biomarkers along with baseline cardiovascular risk and established diagnosis of ED have demonstrated essential role in the predictive ability of ED. Of special interest is the effect of pharmacological treatment of ED, as it appears that this may also have a per se beneficial impact on risk. These findings support better implementation of ED into clinical practice and stress the need to establish standardized methods to diagnose ED and to investigate the potential effect of treatment of ED on cardiovascular events and all-cause mortality.

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Abbreviations

ABI:

Ankle-brachial index

CAC:

Coronary artery calcium

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CfPWV:

Carotid-femoral pulse wave velocity

CI:

Confidence intervals

CV:

Cardiovascular

CVD:

Cardiovascular disease

ED:

Erectile dysfunction

HF:

Heart failure

IL-6:

Interleukin-6

IMT:

Intima-media thickness

MACE:

Major adverse cardiac events

ONTARGET:

ONgoing Telmisartan Alone and in combination with ramipril global endpoint trial

PSV:

Peak systolic velocity

RR:

Relative risk

SCORE:

Systematic coronary risk evaluation

TOM:

Testosterone in older men with mobility limitations

TRANSCEND:

Telmisartan randomized assessment study in ACE intolerant subjects with cardiovascular disease

VITAL:

Vitamins and lifestyle

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Authors and Affiliations

  1. 1st Department of Cardiology, Cardiovascular Diseases and Sexual Health Unit, Athens Medical School, Athens, Greece

    Dimitrios Terentes-Printzios & Charalambos Vlachopoulos

Authors
  1. Dimitrios Terentes-Printzios
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  2. Charalambos Vlachopoulos
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Correspondence to Dimitrios Terentes-Printzios .

Editor information

Editors and Affiliations

  1. Tallinn University of Technology, North Estonia Medical Centre, Tallinn, Estonia

    Margus Viigimaa

  2. Athens Medical School, Athens, Greece

    Charalambos Vlachopoulos

  3. Internal Medicine, Aristotle University, Thessaloniki, Greece

    Michael Doumas

Glossary

Ankle-brachial index

 It is the ratio of the blood pressure in the lower legs (posterior tibial artery or dorsalis pedis artery) to the blood pressure in the arms (brachial artery).

Arterial stiffness

 It is the reduced capability of an artery to expand in response to pressure changes.

Pulse wave velocity

 It is the distance traveled (Δx) by the pressure wave divided by the time (Δt) for the wave to travel that distance.

Vascular biomarkers

 Biomarkers that originate from changes in function or structure of blood vessels such as aortic stiffness, carotid intima-media thickness, coronary artery calcium calcification, and endothelial function.

Vasculogenic ED

 It is diagnosed when the peak systolic velocity (PSV) is less than 35 cm/s and/or when the end-diastolic velocity (EDV) is greater than 5 cm/s in penile Doppler.

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Terentes-Printzios, D., Vlachopoulos, C. (2015). The Prognostic Role of Erectile Dysfunction for Cardiovascular Events. In: Viigimaa, M., Vlachopoulos, C., Doumas, M. (eds) Erectile Dysfunction in Hypertension and Cardiovascular Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-08272-1_9

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  • DOI: https://doi.org/10.1007/978-3-319-08272-1_9

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