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Vascular and Chronological Age in Men With Erectile Dysfunction: A Longitudinal Study
Giulia Rastrelli1, Giovanni Corona2, Edoardo Mannucci3
1Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
Insights
The difference between vascular and chronological age (Δage) predicts major adverse cardiovascular (CV) events (MACE) in men with erectile dysfunction (ED). This risk assessment is particularly valuable for low-risk individuals and independent of other CV factors.
Area of Science:
- Cardiology
- Vascular Medicine
- Men's Health
Background:
- Impaired penile vascularity on Doppler ultrasound predicts major adverse cardiovascular (CV) events (MACE), especially in low-risk men.
- Penile Doppler ultrasound is not routinely recommended for cardiovascular risk assessment.
Purpose of the Study:
- To determine if the difference between vascular and chronological age (Δage), calculated using the SCORE algorithm, predicts MACE in men seeking evaluation for erectile dysfunction (ED).
- To assess if Δage is an independent predictor of MACE, even when considering other CV risk factors and penile Doppler ultrasound parameters.
Main Methods:
- Retrospective analysis of 1687 male patients initially presenting for ED.
- SCORE algorithm applied to 841 patients; 739 MACE-free patients analyzed.
- Vascular age derived from SCORE, Δage calculated; MACE data obtained from the City of Florence Registry Office.
Main Results:
- Δage was significantly associated with incident MACE.
- This association persisted in low-risk subjects (younger age, no CV family history, no metabolic syndrome) even after adjusting for confounders.
- The predictive value of Δage for MACE remained significant, independent of penile Doppler ultrasound findings.
Conclusions:
- In men with ED, Δage serves as a significant predictor of incident MACE, particularly in those at low cardiovascular risk.
- Δage is a cost-effective and safe surrogate marker for penile vascular damage and cardiovascular risk assessment.
- The predictive capability of Δage is independent of traditional CV risk factors and penile vascular parameters.
Introduction:
Impaired penile color Doppler ultrasound predicts major adverse cardiovascular (CV) events (MACE), particularly in men at low-risk. However, penile color Doppler ultrasound is not recommended in routine clinical checkups.
Aim:
To evaluate whether the difference between vascular and chronological age (Δage), as derived from the SCORE algorithm, is a predictor of MACE in subjects consulting for erectile dysfunction (ED) independently from other CV risk factors, including penile color Doppler ultrasound parameters.
Methods:
A consecutive series of 1687 male patients attending the Outpatient Clinic for ED for the first time was retrospectively studied. Among them, the SCORE was applicable in 49.9% (n = 841) men, of whom 87.9% (n = 739) were free from previous MACE and were analyzed.
Main Outcome Measures:
Vascular age was derived from the SCORE algorithm and the Δage was considered. Information on MACE was obtained through the City of Florence Registry Office. MACE were identified using the International Classification of Diseases, and fatal and nonfatal MACE were coded as 410-414 (ischemic heart disease), 420-429 (other heart diseases), or 798-799 (sudden death from cardiac diseases), 430-434 or 436-438 (cerebrovascular disease), and 440 (peripheral arterial disease).
Results:
Δage was associated with incident MACE. When dividing the population according to the median age (56 years), family history of CV diseases, and the presence of metabolic syndrome, the association between Δage and MACE was maintained only in low-risk subjects, even after adjusting for confounders [HR = 1.09(1.03-1.16), 1.05(1.01-1.10) and 1.08(1.01-1.16) for younger men, without CV family history or metabolic syndrome, respectively, all P < .05], including penile color Doppler ultrasound parameters.
Conclusion:
In subjects consulting for ED, Δage is associated with incident MACE, in particular in low-risk men. The prediction of MACE by Δage is independent from other risk factors including penile color Doppler ultrasound parameters, so it can be used as a costless and safe surrogate marker of penile vascular damage.
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