Erectile dysfunction could be an early warning sign of subclinical cardiovascular disease (CVD), especially in young men whose CVD risks aren’t steadily monitored, researchers reported in Vascular Medicine this December.
Subclinical CVD is an independent predictor of CVD events, first author Chukwuemeka U. Osondu, MD, MPH, and co-authors wrote in the study, and its absence is linked to minimal CVD risk, even in the presence of traditional symptoms. It shares a handful of risk factors with erectile dysfunction (ED), such as age, obesity and smoking status, and the conditions are thought to have shared mechanisms.
However, Osondu and colleagues said, studies linking the two are limited by “less than ideal” sample sizes.
“Delineating a consistent, strong association of ED with subclinical CVD will help in establishing ED as a simple and effective marker of underlying subclinical CVD,” the authors wrote. “In such an instance, measures of ED could be a simple, effective CVD risk stratification tool, particularly in young men who are less likely to undergo aggressive CVD risk assessment and management.”
A faint association between CVD and ED, which affects around 18 percent of the adult male population, has been established in previous studies, they said, but no strong tie exists.
Subclinical CVD risk is typically measured through non-invasive means, with the most common being the coronary artery calcium (CAC) score and carotid intima-media thickness (cIMT). Markers of endothelial function such as brachial artery flow-mediated dilation (FMD), in addition to other indicators of vascular function, are also popular.
Osondu et al. scoured various medical databases for studies exploring the relationship between these biomarkers and ED, finding 28 studies that met their search criteria. Through random effects meta-analysis and meta-regression, they discovered a strong association between ED and subclinical CVD.
ED was associated with a 2.64-percentage point reduction in FMD compared to patients without ED, they found, and individuals with ED also had a 0.09-mm higher cIMT score than their counterparts. The age of study populations, study quality, publication date and ED assessment questionnaires had no bearing on the eventual results of the authors’ analysis.
In contrast, the relationship between ED and CAC proved inconclusive. CAC assessments are the most accurate predictors of coronary artery disease, Osondu and colleagues wrote, but varying results in small-scale studies failed to either prove or refute a relationship between the two.
“This study demonstrate an association between ED and measures of subclinical CVD, shedding more light on the relationship between ED and CVD, and suggests that ED may be useful in CVD risk stratification,” the authors said. “Future research should focus on determining the longitudinal relationship between ED and subclinical CVD and should involve larger sample sizes.”