Peripheral Atherosclerosis in Patients with Erectile Dysfunction: A Population-Based Study

Abstract

Introduction The presence of erectile dysfunction (ED) could be a warning of vascular disease in different arterial territories. Aim The aim of this study was to investigate the association between ED and the presence of atherosclerosis in 2 different vascular beds: carotid and lower limbs. Methods A total of 614 volunteers between 45 and 74 years of age (mean age 61.0 years) were randomly selected from the general population. ED was assessed using the International Index of Erectile Function (IIEF-5). Ankle-brachial index (ABI) measurement and carotid atherosclerosis were evaluated by echo-Doppler. Main Outcome Measures Mean carotid intima-media thickness (IMT), prevalence of carotid plaques, mean ABI, and prevalence of ABI < 0.9 were the main outcome measures. Results ED was present in 373 subjects (59.7%). Mean carotid IMT was significantly higher in men with ED (0.762 ± 0.151 mm vs 0.718 ± 0.114 mm, P < .001). Also the global prevalence of carotid plaques was more frequent in men with ED (63.8% vs 44.8%, P < .001), even after adjusting by age, cardiovascular risk factors, and ongoing treatment (P = .039). Both the IMT and the prevalence of carotid plaques increased significantly with ED severity (P trend .004 and <.001, respectively). There were no significant differences between groups neither in mean ABI nor in the prevalence of subjects with ABI < 0.9. However, there was a trend to a lower ABI and a higher prevalence of ABI < 0.9 with increasing ED severity. Conclusion In the general population, the presence of ED identifies subjects with higher atherosclerosis burden in carotid arteries but not in the lower extremities.

The global prevalence of erectile dysfunction: a review

“…The association between HTN, dyslipidaemia and ED remains controversial. Lahoz et al [57] found no significant association between ED and HTN, elevated cholesterol or triglycerides. Equally, de Boer et al [22] found the risk of HTN in ED patients to be 0.83 (95% CI 0.56-1.25).…”

“…When compared to men without ED, men with ED were at increased risk of ischaemic heart disease (1.08-1.87) [ [22,26,35,47,51,54] (Appendix S1 [5,16,22,26,29,35,47,51,[53][54][55][56][57][58][59]). The risk of CVD was positively associated with severity of ED [35,53,55] and increasing age [26].…”

“…Men with ED are 1.33-6.24-times more likely to have BPH than men without ED [18,23,[31][32][33]35,57,[61][62][63] (Appendix S2 [14,18,23,[31][32][33]35,56,61,62,64,65]). Prevalence of ED and BPH ranged from 5.2% to 40% [64,65] and prevalence was positively associated with increasing age [64].…”

Erectile dysfunction – overview from a cardiovascular perspective

“…ED was shown to be an independent predictor of peripheral artery disease (PAD) defi ned as an ABI < 0.9 [22]. On the other hand, an ABI of < 0.9 is of limited predictive value to diagnose ED in the general population [23]. Only in diabetic and cardiovascular highrisk patients (Framingham Risk Score), an ABI of < 0.9 may be associated with and be predictive for ED [23].…”

“…On the other hand, an ABI of < 0.9 is of limited predictive value to diagnose ED in the general population [23]. Only in diabetic and cardiovascular highrisk patients (Framingham Risk Score), an ABI of < 0.9 may be associated with and be predictive for ED [23]. In line, cardiovascular risk stratifi cation in patients with suspected ED using the Framingham Risk Score is promoted by some in order to determine the diagnostic work-up [24].…”