Vascular Erectile Dysfunction and Subclinical Cardiovascular Disease

Abstract

Purpose of review We review the recent literature on the hypothesized temporal relationship between subclinical cardiovascular disease (CVD), vascular erectile dysfunction (ED), and clinical CVD. In addition, we combine emerging research with expert consensus guidelines such as The Princeton Consensus III to provide a preventive cardiologist’s perspective toward an ideal approach to evaluating and managing CVD and ED risk in patients. Recent findings Development of ED was found to occur during the progression from subclinical CVD to clinical CVD. A strong association was observed between subclinical CVD as assessed by coronary artery calcium (CAC) and carotid plaque and subsequent ED, providing evidence for the role of subclinical CVD in predicting ED. ED is also identified as a substantial independent risk factor for overt clinical CVD, and ED symptoms may precede CVD symptoms by 2–3 years. Summary Given the body of evidence on the relationship between subclinical CVD, ED, and clinical CVD we recommend that all men with vascular ED should undergo cardiovascular risk assessment. We further recommend using CAC scores for advanced risk assessment in patients at low-intermediate to intermediate risk (5–20% CVD risk), with risk driving subsequent lifestyle and pharmacologic treatment decisions.

2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC)

“…337À341 There is strong evidence that CVD risk assessment is needed in men presenting with ED. 336,342 In men with ED and low-to-intermediate CVD risk, detailed risk profiling by, for example, CAC score is suggested, but so far not supported by evidence. 338,341 Assessment of ED severity and physical examination should be part of the first-line CVD risk assessment in men.…”

Effect of new oral direct acting antiviral therapy on sexual function in male patients with hepatitis C virus

“…The association between HCV and atherosclerosis is an emerging topic (Goossens & Negro, 2017; Ishizaka, Ishizaka, & Yamkado, 2014; Katsi et al., 2015). Atherosclerosis is an important contributor for sexual dysfunction (Gowani et al., 2017; Miner et al., 2019). The DAA therapy had advantage of improvement of atherosclerosis (Butt et al., 2019; Ichikawa et al, 2019) and therefore is beneficial in sexual function in patients with HCV.…”

Can Erectile Dysfunction Severity Predict Major Adverse Cardiovascular Events in Men Undergoing Dialysis? A Prospective Cohort Study

“…Based on the theory that progressive occlusive atherosclerotic disease may manifest earlier in smaller penile arteries than in larger coronary arteries [ 9 ], numerous studies have demonstrated the predictive ability of ED for future CVD events [ 10 11 ]. The ED symptoms precede clinically overt CVD by 2–3 years [ 12 13 ], and more severe ED is associated with an increased risk of CVD [ 14 15 ]. However, it remains unclear whether severe ED can predict future CVD events in men undergoing dialysis, who are generally recognized as at high-risk for accelerated atherosclerosis [ 16 ].…”