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Erectile dysfunction as a predictor of cardiovascular disease

International Journal of Impotence Research volume 20, pages 460–465 (2008)Cite this article

Abstract

Although it has been recognized that erectile dysfunction (ED) and coronary artery disease share many of the same risk factors—smoking, dyslipidemia, diabetes and hypertension—just in the past few years several new studies now suggest that ED is an important early marker of the presence of coronary artery disease. Recent analyses suggest that ED symptoms occur prior to coronary artery disease symptoms and may be a predictor of future major cardiovascular events. Some of these new studies also suggest that ED is an independent risk factor for predicting cardiovascular events—that is independent of other well-established risk factors. Taken together, these new studies suggest that when a patient presents with ED, the patient should be questioned about cardiac health and cardiovascular risk factors. If cardiovascular risk factors are identified, they should be worked up and aggressively treated—as treatment of these risk factors may be life-saving.

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References

  1. Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts Male Aging Study. Prev Med 2000; 30: 328–338.

    Article  CAS  PubMed  Google Scholar 

  2. NIH Consensus Development Panel on Impotence. NIH Consensus Conference: impotence. JAMA 1993; 270: 83–90.

    Article  Google Scholar 

  3. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB . Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.

    Article  CAS  PubMed  Google Scholar 

  4. Virag R, Bouilly P, Frydman D . Is impotence an arterial disorder? A study of arterial risk factors in 440 impotent men. Lancet 1985; 1: 181–184.

    Article  CAS  PubMed  Google Scholar 

  5. O’Kane PD, Jackson G . Erectile dysfunction: is there silent obstructive coronary artery disease? Int J Clin Pract 2001; 55: 219–220.

    PubMed  Google Scholar 

  6. Pritzker MP . The penile stress test: a window to the hearts of man? Circulation 1999; 100 (Suppl 1): 1:711.

    Google Scholar 

  7. Kloner RA, Mullin SH, Shook T, Matthews R, Mayeda G, Burstein S et al. Erectile dysfunction in the cardiac patient: how common and should we treat? J Urology 2003; 170: S46–S50.

    Article  Google Scholar 

  8. Kloner RA, Padma-Nathan H . Erectile dysfunction in patients with coronary artery disease. Int J Impot Res 2005; 17: 209–215.

    Article  CAS  PubMed  Google Scholar 

  9. Blumentals WA, Gomez-Caminero A, Joo S, Vannappagari V . Should erectile dysfunction be considered as a marker for acute myocardial infarction? Results from a retrospective cohort study. Int J Impot Res 2004; 16: 350–353.

    Article  CAS  PubMed  Google Scholar 

  10. Montorsi F, Briganti A, Salonia A, Rigatti P, Margonato A, Macchi A et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol 2003; 44: 360–365.

    Article  PubMed  Google Scholar 

  11. Speel TGW, van Langen H, Meuleman EJH . The risk of coronary heart disease in men with erectile dysfunction. Eur Urol 2003; 44: 366–371.

    Article  CAS  PubMed  Google Scholar 

  12. Roumeguére Th, Wespes E, Carpentier Y, Hoffmann P, Schulman CC . Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk. Eur Urol 2003; 44: 355–359.

    Article  PubMed  Google Scholar 

  13. Gazzaruso C, Giordanetti S, De Amici E, Bertone G, Falcone C, Geroldi D et al. Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation 2004; 110: 22–26.

    Article  PubMed  Google Scholar 

  14. 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 

  15. Min JK, Williams KA, Okwuosa TM, Bell GW, Panutich MS, Ward RP . Prediction of coronary heart disease by erectile dysfunction in men referred for nuclear stress testing. Arch Intern Med 2006; 166: 201–206.

    Article  PubMed  Google Scholar 

  16. Baumhäkel M, Böhm M . Erectile dysfunction correlates with left ventricular function and precedes cardiovascular events in cardiovascular high risk patients. Int J Clin Pract 2007; 61: 361–366.

    Article  PubMed  Google Scholar 

  17. Montorsi P, Montorsi F, Schulman CC . Is erectile dysfunction the ‘Tip of the iceberg’ of a systemic vascular disorder? Eur Urol 2003; 44: 352–354.

    Article  PubMed  Google Scholar 

  18. Billups KL . Endothelial dysfunction as a common link between erectile dysfunction and cardiovascular disease. Curr Sex Health Rep 2004; I: 137–141.

    Article  Google Scholar 

  19. Kirby M, Jackson G, Simonsen U . Endothelial dysfunction links erectile dysfunction to heart disease. Int J Clin Pract 2005; 59: 225–229.

    Article  CAS  PubMed  Google Scholar 

  20. Cheitlin MD . Erectile dysfunction: the earliest sign of generalized vascular disease? JACC 2004; 43: 185–186.

    Article  PubMed  Google Scholar 

  21. Bivalacqua TJ, Usta MF, Champion HC, Kadowitz PJ, Hellstrom WJG . Endothelial dysfunction in erectile dysfunction: role of the endothelium in erectile physiology and disease. J Androl 2003; 24: S17–S37.

    Article  CAS  PubMed  Google Scholar 

  22. Guay AT . Relation of endothelial cell function to erectile dysfunction: implications for treatment. Am J Cardiol 2005; 96 (suppl): 52M–56M.

    Article  CAS  PubMed  Google Scholar 

  23. Kaiser DR, Billups K, Mason C, Wetterling R, Lundberg JL, Bank AJ . Impaired brachial artery endothelium-dependent and -independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J Am Coll Cardiol 2004; 43: 179–184.

    Article  PubMed  Google Scholar 

  24. Kaya C, Uslu Z, Karaman I . Is endothelial function impaired in erectile dysfunction patients? Int J Impot Res 2006; 18: 55–60.

    Article  CAS  PubMed  Google Scholar 

  25. Bocchio M, Desideri G, Scarpelli P, Necozione S, Properzi G, Spartera C et al. Endothelial cell activation in men with erectile dysfunction without cardiovascular risk factors and overt vascular damage. J Urol 2004; 171: 1609–1610.

    Article  Google Scholar 

  26. Kostis JB, Jackson G, Rosen R, Barrett-Connor E, Billups K, Burnett AL et al. Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). Am J Cardiol 2005; 96: 313–321.

    Article  PubMed  Google Scholar 

  27. Kloner RA . Erectile dysfunction and cardiovascular risk factors. Urol Clin N Am 2005; 32: 397–402.

    Article  Google Scholar 

  28. Derby CA, Mohr BA, Goldstein I, Feldman HA, Johannes CB, McKinlay JB . Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk? Urology 2000; 56: 302–306.

    Article  CAS  PubMed  Google Scholar 

  29. Esposito K, Giugliano F, DiPalo C, Giugliano G, D’Andrea R, D’Armiento M et al. Effect of lifestyle changes on erectile dysfunction in obese men. JAMA 2004; 291: 2978–2984.

    Article  CAS  PubMed  Google Scholar 

  30. Shabsigh R, Fishman IJ, Schum C, Dunn JK . Cigarette smoking and other vascular risk factors in vasculogenic impotence. Urology 1991; 38: 227–232.

    Article  CAS  PubMed  Google Scholar 

  31. Fogari R, Zoppi A, Poletti L, Marasi G, Mugellini A, Corradi L . Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. Am J Hypertens 2001; 14: 27–31.

    Article  CAS  PubMed  Google Scholar 

  32. Pourmand G, Alidaee MR, Rasuli S, Maleki A, Mehrsai A . Do cigarette smokers with erectile dysfunction benefit from stopping? A prospective study. BJU Int 2004; 94: 1310–1313.

    Article  PubMed  Google Scholar 

  33. Sighinolfi MC, Mofferdin A, De Stefani S, Micali S, Cicero AF, Bianchi G . Immediate improvement in penile hemodynamics after cessation of smoking: previous results. Urology 2007; 69: 163–165.

    Article  CAS  PubMed  Google Scholar 

  34. Herrmann HC, Levine LA, Macaluso Jr J, Walsh M, Bradbury D, Schwartz S et al. Can atorvastatin improve the response to sildenafil in men with erectile dysfunction not initially responsive to sildenafil? Hypothesis and pilot trial results. J Sex Med 2006; 3: 303–308.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Heart Institute, Good Samaritan Hospital, Los Angeles, CA, USA

    R A Kloner

  2. Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    R A Kloner

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  1. R A Kloner
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Correspondence to R A Kloner.

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Kloner, R. Erectile dysfunction as a predictor of cardiovascular disease. Int J Impot Res 20, 460–465 (2008). https://doi.org/10.1038/ijir.2008.20

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