If followed, the cholesterol guidelines published in late 2013 will increase the timing and frequency of initiating statin therapy in men, according to an editorial published in the July 11 issue of the Journal of Men’s Health. The authors added that the guidelines overlooked erectile dysfunction as a risk factor for coronary artery disease.
Cardiologist Stephen L. Kopecky, MD, of the Mayo Clinic in Rochester, Minn., and urologist Ajay Nehra, MD, of Rush University Medical Center in Chicago, evaluated the American Heart Association/American College of Cardiology guidelines for preventing cardiovascular atherosclerotic disease from the perspective of men’s health. The guidelines set a 7.5 percent risk at 10 years as the bar for weighing the benefit and risk of treatment.
“The guidelines reiterate a key concept that has been known for decades—that men are at higher risk for cardiovascular disease than women at any age with similar risk factors,” they wrote. Adhering to guideline recommendations consequently will mean physicians and their male patients will consider starting statin therapy more often and at an earlier age than previously.
Kopecky and Nehra described the guideline’s risk calculator as user friendly and praised the inclusion of lifetime risk for younger patients. Physicians can use that feature to drill home to younger patients the benefits of lifestyle changes that would reduce the risk of developing atherosclerosis.
The guidelines failed to include erectile dysfunction as a risk factor, though. The authors emphasized that erectile dysfunction is a marker for coronary artery disease, and that younger men with erectile dysfunction are at significantly higher risk than young men without erectile dysfunction. Men who adopt a heart-healthy lifestyle see improvements in erectile dysfunction and lower their risk.
They recommended considering other risk factors and diseases that share those risk factors. “[B]eing male increases risk for multiple diseases, not just cardiovascular disease. It should be emphasized to all men that proper management of cardiovascular risk factors also reduces their risk of ED [erectile dysfunction], DM [diabetes mellitus], and dementia."
For more on the guidelines, read “Cholesterol Conundrum: Making Guidelines Work for You.”