Advice to docs: Ask young men with CV risk factors about ED

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In recent years, cardiologists have been building a case for erectile dysfunction (ED) as a predictor of cardiovascular disease (CVD) in men. Based on a literature review of this work, a multidisciplinary, international team of researchers recommended in the July issue of the American Heart Journal that physicians query all young and middle-age men with CV risk factors about ED symptoms.

Martin Miner, MD, chief of family medicine and co-director of the Men’s Health Center at Miriam Hospital in Providence, R.I., and colleagues focused on evidence that examined ED as a risk marker for CVD in men who are younger than 60 years and in men with diabetes. They noted that ED and CVD share several risk factors such as smoking, hypertension, hyperlipidemia and a family history for MI.

They reviewed 40 studies on the predictive value of ED of CV events in younger men. For instance, they highlighted results from a patient-based longitudinal study that found that when ED occurs in younger men, it is associated with a marked increase in future CV events. The same study concluded that ED had little prognostic importance in older men (Mayo Clin Proc 2009;84:108-113).

The authors also wrote that the literature supported the view that ED is highly prevalent among men with type 2 diabetes mellitus. For instance, the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) study involving 6,300 men with type 2 diabetes mellitus and a five-year follow-up found that baseline ED was associated with an increased risk for CVD events, coronary heart disease and cerebrovascular disease (J Am Coll Cardiol 2010;56:1908-1913).

“Although it is not known whether ED has stronger predictive power for CVD in diabetics than in non-diabetics, the literature clearly supports greater cardiovascular risk among diabetics with ED than those without,” Miner and colleagues wrote. “Thus, all men with DM2 [type 2 diabetes mellitus] and new-onset ED should undergo thorough cardiovascular risk evaluation.”

The authors also examined the possible pathophysiologic links between ED and CVD, studies that looked at the addition of ED to traditional CV risk factors for predicting CVD and potential prognostic markers of vascular disease. They wrote that based on the literature review, ED was a strong predictor of CVD in younger and middle-age men. They added that men with type 2 diabetes and ED were at greater risk of a cardiovascular event than diabetic men without ED.

“[I]dentification of ED represents an important first step toward CVD risk detection and reduction,” they concluded. “Although not all men with ED are at increased cardiovascular risk, it is the clinician’s obligation to characterize cardiovascular risk through aggressive workup and diagnostics and to initiate intensive risk factor management in appropriate patients.”