On SAGE Insight: Erectile dysfunction is red flag for silent early cardiovascular disease

Article title: The relationship of erectile dysfunction and subclinical cardiovascular disease: A systematic review and meta-analysis

From Vascular Medicine

In addition to being an important health and quality of life issue for men, erectile dysfunction has long been associated with CV disease. Risk factors for erectile dysfunction and CV disease are similar including older age, smoking, obesity, and diabetes, among others. In addition, multiple overlapping mechanisms lead to the development of both erectile dysfunction and CV disease.

In this article Drs. Chukwuemeka Osondu (Baptist Health South Florida), Bryan Vo (Florida International University), Ehimen Aneni (Mount Sinai Medical  Center), and colleagues sought to establish erectile dysfunction as a simple and effective marker of underlying subclinical CV disease.They hypothesized that “measures of erectile dysfunction could be a simple effective CV disease risk stratification tool, particularly in young men who are less likely to undergo aggressive CVD risk assessment and management.”

The authors conducted a systematic review and meta-analysis of 28 studies that examined the link between erectile dysfunction and measures of early CV disease. They report a significant association of erectile dysfunction 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 report that erectile dysfunction was associated with increased carotid intimal medial thickness (carotid IMT), an early manifestation of atherosclerosis. The results for the association of erectile dysfunction and coronary artery calcium scoring were inconclusive due to small number of studies with limited sample size. The authors identify this as an area in need of future study.

As explained by the authors, “Our study findings indicate that [young] men [with erectile dysfunction] 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 categorized as low risk due to their young ages.”


Erectile dysfunction (ED) is associated with cardiovascular disease (CVD) and CVD mortality. However, the relationship between ED and subclinical CVD is less clear. We synthesized the available data on the association of ED and measures of subclinical CVD. We searched multiple databases for published literature on studies examining the association of ED and measures of subclinical CVD across four domains: endothelial dysfunction measured by flow-mediated dilation (FMD), carotid intima–media thickness (cIMT), coronary artery calcification (CAC), and other measures of vascular function such as the ankle–brachial index, toe–brachial index, and pulse wave velocity. We conducted random effects meta-analysis and meta-regression on studies that examined an ED relationship with FMD (15 studies; 2025 participants) and cIMT (12 studies; 1264 participants). ED was associated with a 2.64 percentage-point reduction in FMD compared to those without ED (95% CI: –3.12, −2.15). Persons with ED also had a 0.09-mm (95% CI: 0.06, 0.12) higher cIMT than those without ED. In subgroup meta-analyses, the mean age of the study population, study quality, ED assessment questionnaire (IIEF-5 or IIEF-15), or the publication date did not significantly affect the relationship between ED and cIMT or between ED and FMD. The results for the association of ED and CAC were inconclusive. In conclusion, 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 persons with ED.

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Article details
The relationship of erectile dysfunction and subclinical cardiovascular disease: A systematic review and meta-analysis
Chukwuemeka U Osondu, Bryan Vo, Ebenezer T Oni, Michael J Blaha, Emir Veledar, Theodore Feldman, Arthur S Agatston, Khurram Nasir, Ehimen C Aneni
DOI: 10.1177/1358863X17725809
First Published December 15, 2017
From Vascular Medicine



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