ED: a red flag for silent early CVD
Erectile dysfunction (ED) is an important marker of subclinical cardiovascular disease, according to a new study from the US.
A systematic review and meta-analysis of 28 studies, was designed to assess whether ED could be a simple and effective CV disease risk stratification tool, particularly in young men who are less likely to undergo aggressive CVD risk assessment and management.
There was a significant association of ED with impaired endothelial function (measured by brachial flow-mediated dilation using ultrasound), a marker of the ability of blood vessels to relax that is an early event in vascular disease development. In addition, the authors reported that ED was associated with increased carotid intimal medial thickness (carotid IMT), an early manifestation of atherosclerosis. The results for the association of ED and coronary artery calcium scoring were inconclusive due to small number of studies with limited sample size.
The authors commented, "Our study findings indicate that [young] men [with ED] are at greater risk of having identifiable subclinical CV disease and will benefit from an active CV disease work-up…Our study supports a more aggressive CV disease risk assessment and management for persons with erectile dysfunction, including young men who may otherwise be categorised as low risk due to their young ages."
An accompanying editorial said, "The findings add to the growing evidence supporting additional trials to determine the clinical impact of ED screening and the appropriate cardiovascular-directed evaluation and treatment of men with ED."
This study confirms an association between ED and subclinical CVD and may shed additional light on the shared mechanisms between ED and CVD, underscoring the importance of aggressive CVD risk assessment and management in men with ED.
- Osondu CU, et al. The relationship of erectile dysfunction and subclinical cardiovascular disease: A systematic review and meta-analysis. Vasc Med Epub ahead of print: 15 December
- Kluge MA, Hamburg NM. Erectile dysfunction in the trajectory of cardiovascular disease. Vascular Medicine 2017; epub ahead of print, 15 December