Platinum Priority – Collaborative Review – AndrologyEditorial by Hillary A. Keenan on pp. 979–980 of this issueA Systematic Review of the Association Between Erectile Dysfunction and Cardiovascular Disease
Introduction
Erectile dysfunction (ED) is defined as the recurrent or consistent inability to obtain and/or maintain a penile erection sufficient for satisfactory sexual performance [1]. The incidence of ED increases with age, reaching 20–40% in men 60–69 yr of age and 50–100% in men in their 70s and 80s, depending on the differing definitions of ED in various studies [2]. Beyond the aging process, other cardiovascular (CV) risk factors such as hypertension, diabetes, smoking, obesity, and dyslipidemia have been shown to be significantly associated with ED [3], [4]. For this reason, a correlation between ED and cardiovascular disease (CVD) has been hypothesized, and ED has been proposed as an early manifestation of a larger subclinical systemic disorder that might subsequently result in CVD [5], [6].
This review analyzes the relationship between ED and CVD by addressing the pathophysiologic links between these two conditions and by examining the role of ED as an early sign of symptomatic CVD. We also focus on the clinically relevant aspects of this association, in order to identify which patients would benefit from a detailed cardiologic assessment.
Section snippets
Evidence acquisition
A systematic literature review was performed in May 2013 using the Medline, Embase, and Web of Science databases. The search strategy included the terms erectile dysfunction, coronary artery disease, cardiovascular disease, risk factors, pathophysiology, artery-size hypothesis, atherosclerosis, low androgen levels, inflammation, screening, and phosphodiesterase type 5 inhibitors, alone or in combination. We limited our search to prospective trials and major preclinical and retrospective studies
Clinical evidence of association between erectile dysfunction and cardiovascular disease: common risk factors
ED is commonly considered a vascular disease, and it is well known to share many risk factors with CVD such as aging, hypertension, smoking, diabetes, obesity, and metabolic syndrome [3], [4]. In this context, a large prospective trial evaluating the impact of CV risk factors on erectile function during a 25-yr follow-up clearly showed that age, body mass index (BMI), cholesterol, and triglycerides were significantly associated with ED [4]. Additional CV risk factors such as smoking, BMI,
Conclusions
ED and CVD should be considered two different manifestations of the same systemic disorder. The link between these conditions resides in the interaction between CV risk factors, androgens, and chronic inflammation, which leads to atherosclerosis and flow-limiting stenosis. Macroscopically invisible alterations, such as endothelial dysfunction and autonomic hyperactivity, might in part explain the complex relationship between ED and CVD. ED usually precedes CVD, and its diagnosis offers a window
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