Cardiovascular Disease Prevention in Men with Vascular Erectile Dysfunction: The View of the Preventive Cardiologist.

Nishant P Shah, Miguel Cainzos-Achirica, David I Feldman, Roger S Blumenthal, Khurram Nasir, Martin M Miner, Kevin L Billups, Michael J Blaha

Journal: The American journal of medicine 2016;129(3):251-9

PMID: 26477950

Full Text on Elsevier Science View on PubMed

Abstract

Vascular erectile dysfunction is a powerful marker of increased cardiovascular risk. However, current guidelines lack specific recommendations on the role that the evaluation of vascular erectile dysfunction should play in cardiovascular risk assessment, as well on the risk stratification strategy that men with vascular erectile dysfunction should undergo. In the last 3 years, erectile dysfunction experts have made a call for more specific guidance and have proposed the selective use of several prognostic tests for further cardiovascular risk assessment in these patients. Among them, stress testing has been prioritized, whereas other tests are considered second-line tools. In this review, we provide additional perspective from the viewpoint of the preventive cardiologist. We discuss the limitations of current risk scores and the potential interplay between erectile dysfunction assessment and the use of personalized prognostic tools, such as the coronary artery calcium score, in the cardiovascular risk stratification and management of men with vascular erectile dysfunction. Finally, we present an algorithm for primary care physicians, urologists, and cardiologists to aid clinical decision-making.

Address: Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Md.; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Md; Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Md.; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Md; Baptist Health South Florida, Miami, Fla.; Department of Family Medicine and Urology, Miriam Hospital and Brown University, Providence, RI.; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Md; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Md.; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Md. Electronic address: [email protected].

DOI: 10.1016/j.amjmed.2015.08.038

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MeSH Terms: Algorithms, Ankle Brachial Index, Cardiovascular Diseases, Carotid Intima-Media Thickness, Clinical Decision-Making, Coronary Angiography, Echocardiography, Stress, Humans, Impotence, Vasculogenic, Male, Prognosis, Risk Assessment, Risk Management, Vascular Calcification