Purpose: We established erectile dysfunction as an often neglected but
valuable marker of cardiovascular risk, particularly in younger men and
men with diabetes. We also reviewed evidence that lifestyle change,
combined with informed prescribing of pharmacotherapies used to mitigate
cardiovascular risk, can improve overall vascular health and sexual
functioning in men with erectile dysfunction.
Materials and Methods: We performed a PubMed (R) search for articles and
guidelines pertinent to relationships between erectile dysfunction and
cardiovascular disease, cardiovascular and all cause mortality, and
pharmacotherapies for dyslipidemia and hypertension. The clinical
guidance presented incorporates the current literature and the expertise
of the multispecialty investigator group.
Results: Numerous cardiovascular risk assessment tools exist but risk
stratification remains challenging, particularly in patients at low or
intermediate short-term risk. Erectile dysfunction has a predictive
value for cardiovascular events that is comparable to or better than
that of traditional risk factors. Interventional studies support
lifestyle changes as a means of improving overall vascular health as
well as sexual functioning. Statins, diuretics, beta-blockers and
renin-angiotensin system modifiers may positively or negatively affect
erectile function. Furthermore, the phosphodiesterase type 5 inhibitors
used to treat erectile dysfunction may have systemic vascular benefits.
Conclusions: Erectile dysfunction treatment should be considered
secondary to decreasing cardiovascular risk. However, informed
prescribing may prevent worsening sexual function in men receiving
pharmacotherapy for dyslipidemia and hypertension. As the first point of
medical contact for men with erectile dysfunction symptoms, the primary
care physician or urologist has a unique opportunity to identify those
who require early intervention to prevent cardiovascular disease