Cardiovascular risk evaluation for all men should include assessment of sexual function

August 30, 2012

Assessment of sexual function should be incorporated into cardiovascular risk evaluation for all men, regardless of the presence or absence of known cardiovascular disease, according to Dr. Ajay Nehra, lead author of a report by the Princeton Consensus (Expert Panel) Conference, a collaboration of 22 international, multispecialty researchers. Nehra is vice chairperson, professor and director of Men's Health in the Department of Urology at Rush University Medical Center in Chicago.

Erectile dysfunction (ED) is a red flag in , less than 55 years of age for future cardiac morbidity or mortality – death or disease – for cardiovascular disease (CVD). In some patients, the time window between onset of ED and a may be two to five years.

"Any man with ED should be considered at a substantially higher increase until further testing can be done," said Nehra. "Erectile dysfunction often occurs in the presence of silent, non-symptomatic cardiovascular disease; and hence this is an opportunity for cardiovascular risk reduction."

The panel recommends that younger men, more than 30 years old who experience ED receive a thorough, non invasive cardiovascular disease evaluation. As the consensus panel considers all men with ED who are older than 30 to be at increased CVD risk, a thorough noninvasive and, when indicated, invasive evaluation of CVD status is recommended.

They found that younger men who experienced ED were twice as likely to develop cardiovascular disease than men without ED. The highest risk for cardiovascular disease was in younger men.

While controversial, the consensus panel also recommended that testosterone levels be measured in all men diagnosed with organic ED due to an accumulation of recent studies that link low testosterone to ED, CVD and .

"Testosterone levels should be routinely measured. Men with testosterone levels less than 230 have higher risk for all cause and cardiovascular mortality," said Nehra. In population based studies of 500 or more patients, low have increased mortality level.

These and other recommendations for controlling ED and CVD emerged from the Princeton III Meeting on Cardiometabolic Risks and Sexual Health, held in 2010, that were reported in the August 2012 issue of the Mayo Clinic Proceedings.

The purpose of the Princeton III meeting was to find an approach for optimizing and preserving cardiovascular health in men with known CVD. The conference updated findings from the Princeton I and Princeton II meetings, held in 2000 and 2005, respectively.

"The conference focused on the predictive value of vascular erectile dysfunction in assigning cardiovascular risk in men of all ages, the objective being development of a primary approach to cardiovascular risk assessment in younger men with erectile dysfunction and no cardiovascular disease," Nehra said.

The panel's approach broadens the use of the 2010 American College of Cardiology/American Heart Association guideline for assessment of cardiovascular risk in asymptomatic adults to address an at-risk population that the guideline does not mention – men with ED. Even long-term observational studies, such as the well-known Framingham Heart Study, include few data from patients younger than 40 years.

"Experts have been considering the connection between erectile dysfunction and for a while," said Nehra. "Recent data and publications about the connection have become more consistent in linking the two."

There is a growing body of scientific evidence that ED is a particular precursor of CVD in men younger than 40. One study found that men 40 to 49 years of age with ED had a 50-fold higher incidence of new-incident coronary artery disease than those without ED.

In light of this evidence, the panel recommended that the cardiovascular evaluation include an assessment of important indicators of risk that can be seen in certain blood and urine tests, patient and family history and a review of lifestyle factors. Such an evaluation will help stratify the patient's CV risk and guide the next steps in evaluation and treatment.

"That means that doctors treating men for can play a critical role in helping monitor and start reducing a patient's cardiovascular risk, even when the patient has no symptoms," said Nehra.

The new recommendations also emphasize using exercise ability before prescribing treatment for ED to ensure that each man's cardiovascular health is consistent with the physical demands of sexual activity, especially for those who have been identified as having a high risk for CVD.

The panel encouraged a collaborative approach to management of men's sexual function and cardiovascular risk, incorporating general, urologic, endocrine and cardiologic expertise. Scientific evidence suggests that a comprehensive approach to cardiovascular risk reduction will improve overall vascular health, including sexual function, the report said.

The Princeton III panel also strongly urges physicians to inquire about ED symptoms in all men older than 30 years of age with CVD risk factors. "Identification of ED, particularly in younger than 60, represents an important first step toward CVD detection and reduction," the panel concluded.

Explore further: Treatment of CV risk factors appears to improve sexual function in men with erectile dysfunction

Related Stories

Treatment of CV risk factors appears to improve sexual function in men with erectile dysfunction

September 12, 2011
Lifestyle modifications and pharmaceutical treatment of risk factors for cardiovascular disease are associated with improvement in sexual function among men with erectile dysfunction (ED), according to a meta-analysis posted ...

Researchers urge physicians to ask younger men about erectile dysfunction symptoms

July 25, 2012
Although erectile dysfunction (ED) has been shown to be an early warning sign for heart disease, some physicians – and patients – still think of it as just as a natural part of "old age." But now an international ...

Diabetes associated with higher risk of cardiovascular problems in men

March 25, 2012
According to a new study by researchers at Brigham and Women's Hospital (BWH), men with type 2 diabetes treated with insulin without a history of cardiovascular disease (CVD) were at higher risk for major cardiovascular events ...

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.