Erectile Dysfunction, Metabolic Syndrome, and Cardiovascular Risks

Facts and Controversies

Edward Sanchez; Alexander W. Pastuszak; Mohit Khera


Transl Androl Urol. 2017;6(1):28-36. 

In This Article

Links to CVD

A study of 300 men with angiographically documented coronary artery disease (CAD) found that 49% suffered from ED. The study, by Montorsi et al., utilized the validated International Index of Erectile Function (IIEF) to assess ED severity in study subjects.[13] A prospective study by Vlachopoulos et al. examined the incidence of asymptomatic CAD in patients with non-psychogenic, non-hormonal, vasculogenic ED. Ultimately, 19% of subjects were found to have angiographically-documented, but clinically asymptomatic CAD.[14] Both studies found that ED symptoms preceded CAD by a significant time period. In the Vlachopoulos study, onset of symptomatic ED occurred 25 months prior to the discovery of silent CAD.[14] Montorsi's subjects experienced ED symptoms an average of 39 months prior to the onset of CAD symptoms.[13] Studies such as these support the conclusion that patients with ED may be suffering from a more significant, systemic process, and that ED may be a useful predictor of CVD.

The risk of all CV events, myocardial infarction, cerebrovascular events, and all-cause mortality were elevated in men with ED in several meta-analyses.[15,16] These studies support the hypothesis that ED is a silent marker for CVD. Ponholzer et al. calculated the 10-year risk of developing CVD in men with ED using the Framingham Risk Score (FRS), and reported that men with moderate to severe ED had a 43% and 65% increased relative risk for developing coronary heart disease or stroke, respectively.[17] One study evaluated ED's role in disease prediction beyond the FRS. In 2010, Araujo et al. further evaluated data from the MMAS and found that ED was indeed associated with a higher incidence of CAD, but that it did not predict who would develop future CAD better than established risk factors and the FRS.[18] Contrary to this, the Princeton III Consensus Conference suggested that ED itself is an independent marker of increased risk for CVD, CAD, stroke, and all-cause mortality. This consensus panel considered a man with organic ED to be at increased CVD risk until further evaluation suggested otherwise and provided guidance on CV risk screening and stratification.[19]