Men’s health after 50 — what does the bedroom say about your heart?

Aim of the study: Previous studies demonstrating that erectile dysfunction (ED) predicts the risk of further cardiovascular events (CV) events are insufficient to make recommendations for cardiologists, diabetologists, urologists, and more, and the association between CV events and ED degree is unclear. To assess whether ED was a risk factor for CV events in a comprehensive literature review and meta-analysis.

Results: 25 eligible studies involving 154,794 individuals were included in our meta-analysis. Compared with those of men without ED, the CVD risk of ED patients was significantly increased by 43% (relative risk [RR] =1.43; P < .001), CHD was increased by 59% (RR = 1.59; P < .001), stroke was increased by 34% (RR = 1.34; P < .001), and all-cause mortality was increased by 33% (RR = 1.33; P < .001). Older individuals with ED (≥55 years), those with ED of a shorter duration (<7 years), and those with higher rates of diabetes (≥20%) and smoking (≥40%) were more prone to develop CVD. Additionally, severe ED was proven to predict higher CVD and all-cause mortality risk. The standardized model proposed here can be properly applied for screening early CV events. Risk of total CVD, CHD, stroke, and all-cause mortality was significantly increased in populations with ED, and severe ED is of particular concern.

Aim of the study: Despite many advances over the last few decades, cardiovascular disease (CVD) remains the leading cause of death globally, with men afflicted at an earlier age than women.

Results: Importantly, subclinical atherosclerosis appears to precede vascular ED by a decade or longer, with ED preceding clinical CVD such as myocardial infarction and stroke in temporal sequence by about 2-5 years. Crucially, since ED may represent the first presentation of otherwise "healthy" men to care providers, a clinical diagnosis of vascular ED may represent a unique opportunity to identify high risk individuals, intervene, and thus prevent progression to clinical CVD. This review summarizes up-to-date evidence of the relationship between ED and subclinical and clinical CVD, and details the position of current guidelines and clinical recommendations on the role of ED assessment in CVD prevention. Finally, this review proposes a clinical framework for the incorporation of ED into standard CVD risk assessment in middle-age men.

Aim of the study: An association between erectile dysfunction (ED) and cardiovascular (CV) disease (CVD) has long been recognized, and studies suggest that ED is an independent marker of CVD risk. More significantly, ED is a marker for both obstructive and non-obstructive coronary artery disease (CAD) and may reveal the presence of subclinical CAD in otherwise asymptomatic men.

Results: For men with predominantly vasculogenic ED, we recommend that initial CV risk stratification be based on the 2013 American College of Cardiology/American Heart Association atherosclerotic CV disease risk score. Management of men with ED who are at low risk for CVD should focus on risk factor control; men at high risk, including those with CV symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo non-invasive evaluation for subclinical atherosclerosis. Evidence supports use of a prognostic markers, particularly coronary calcium score, to further understand CV risk in men with ED. Clinicians must assess the presence or absence of ED in every man >40 years of age, especially those men who are asymptomatic for signs and symptoms of CAD. We support CV risk stratification and CVD risk factor reduction in all men with vasculogenic ED. Miner M, Parish SJ, Billups KL, et al. Erectile Dysfunction and Subclinical Cardiovascular Disease. Sex Med Rev 2018;7:455-463.

Aim of the study: Cardiovascular disease (CVD) and erectile dysfunction (ED) are two conditions that often coexist. Both diseases are consequences of the systemic vascular disease, sharing common risk factors, like diabetes mellitus, arterial hypertension, smoking, obesity, dyslipidaemia.

Results: Furthermore, they share the same pathological basis, endothelial dysfunction. Symptoms of ED precede with three to five years the clinical manifestations of CVD. This period may be a window of opportunity for the early initiation of a prompt therapeutic action for cardiovascular risk factors. This article reviews the incidence and prevalence of CVD and ED, the common risk factors, the pathophysiological link between the two diseases, and the current diagnosis and management strategies of patients with CVD and ED, in order to prevent myocardial infarction, stroke or heart failure.

Aim of the study: Sexual health has a fundamental role in overall health and well-being, and a healthy and dynamic sex life can make an important contribution to a good quality of life. Sexual dysfunction, and especially erectile dysfunction (ED) in men, is highly prevalent in patients with cardiovascular disease (CVD).

Results: Moreover, ED is a major contributing factor to the discontinuation of, or poor adherence to, cardiovascular therapy. Cardiovascular drugs have divergent effects on erectile function, with diuretics and β-blockers having the worst profiles, and renin-angiotensin-aldosterone system inhibitors and nebivolol having the best profiles. Pharmacological treatment of ED has an equivocal effect on the risk of CVD, suggesting a complex interaction between ED and drugs for CVD. In this Review, we discuss how sexual function could be incorporated into the patient history taken by physicians treating individuals with CVD, not merely as part of the diagnostic work-up but as a means to pursue tangible and essential benefits in quality of life and cardiovascular outcomes.

Aim of the study: Endothelial dysfunction is an important process in the development of atherosclerotic cardiovascular disease, while it is also a major pathophysiological mechanism underlying vasculogenic erectile dysfunction (ED).

Results: Expectedly, these two prevalent disorders are linked also at the clinical level: ED is common in patients with overt and silent coronary artery disease, while ED is increasingly being regarded as the early clinical manifestation of a generalized vascular disease and carries an independent risk for future cardiovascular events. The emerging awareness of ED as a barometer for cardiovascular disease offers a unique opportunity to enhance preventive vascular health in men. Lifestyle and risk factor modification, as well as pharmacologic therapy (both phosphodiesterase type-5 inhibitors and non-ED-targeting drugs), appear to confer additional benefit both in terms of ED treatment and overall cardiovascular risk; this benefit may be related, at least partly, to the improvement of endothelial function and anti-inflammatory effects.

Aim of the study: Erectile dysfunction (ED) is often a comorbid condition commonly associated with cardiovascular disease (CVD). It is important for physicians to understand that the relationship between ED and CVD is not a coincidence but rather a warning signal.

Results: It is important for physicians to understand that the relationship between ED and CVD is not a coincidence but rather a warning signal. The fact that the symptoms of ED normally arise before the symptoms of a cardiovascular event gives physicians the unique opportunity to see the possible future of their patients' cardiovascular health. Vascular disease is the most common cause of ED. This article reviews the incidence of CVD and ED, the pathophysiology of ED, the risk factors associated with ED and CVD, and the evaluation and treatment options for men with ED, and discusses how ED may serve as an early warning for cardiovascular disease.

Aim of the study: The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative symposium dedicated to optimizing sexual function and preserving cardiovascular health. The Fourth Princeton Consensus Conference was convened on March 10-11, 2023, at the Huntington Medical Research Institutes in Pasadena, California.

Results: Thirteen years since Princeton III, Princeton IV builds on previous foundations in several key areas. Mounting evidence supports the need for providers to treat men with ED as being at risk for cardiac events until proven otherwise. Algorithms for the diagnosis and treatment of ED are updated with new recommendations for coronary artery calcium scoring for advanced cardiovascular risk stratification. Optimization of oral phosphodiesterase type 5 inhibitors in the treatment of men with ED and cardiovascular disease is thoroughly explored, including recent evidence of potential cardioprotective effects of these drugs.

Aim of the study: Erectile dysfunction (ED) has evolved from a quality-of-life concern to a recognized marker of systemic vascular disease and an early harbinger of cardiovascular events. The Princeton IV Consensus underscores that men presenting with erectile dysfunction should be presumed at increased cardiovascular risk until proven otherwise, advocating integrated risk stratification and lifestyle optimization.

Results: Erectile dysfunction (ED) has evolved from a quality-of-life concern to a recognized marker of systemic vascular disease and an early harbinger of cardiovascular events. The Princeton IV Consensus underscores that men presenting with erectile dysfunction should be presumed at increased cardiovascular risk until proven otherwise, advocating integrated risk stratification and lifestyle optimization. Beyond established risk scores, advances in omics, vascular imaging, and digital health promise precision tools for early detection and prevention. This review aims to examine erectile dysfunction as an early marker of cardiovascular disease and to summarize current and emerging approaches to cardiovascular risk stratification in men with ED.

Aim of the study: Erectile dysfunction (ED) is a prevalent condition, recognized as a sentinel marker of cardiovascular disease. Epidemiological and mechanistic evidence link ED to cardiovascular risk, with a prominent role of low-grade inflammation, endothelial dysfunction and atherosclerosis.

Results: Erectile dysfunction (ED) is a prevalent condition, recognized as a sentinel marker of cardiovascular disease. Epidemiological and mechanistic evidence link ED to cardiovascular risk, with a prominent role of low-grade inflammation, endothelial dysfunction and atherosclerosis. ED might serve as an early indicator of subclinical vascular disease, and diagnostic strategies, including coronary artery calcium scoring and echocardiography, can be considered to enhance risk stratification. Management approaches that integrate sexual and cardiometabolic health are beneficial to improve care in this at-risk population.