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Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA)
David I Feldman1, Miguel Cainzos-Achirica1,2, Kevin L Billups1,3
1Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Insights
Subclinical cardiovascular disease, especially coronary artery calcium (CAC) and carotid plaque, can predict erectile dysfunction (ED). Early detection of these vascular issues may help identify men at risk for developing ED.
Area of Science:
- Cardiovascular Medicine
- Urology
- Epidemiology
Background:
- The link between subclinical cardiovascular disease and the future development of erectile dysfunction (ED) is not well understood.
- Erectile dysfunction (ED) can be an early indicator of underlying cardiovascular issues.
Purpose of the Study:
- To determine which measures of subclinical atherosclerosis and vascular dysfunction best predict the development of ED.
- To investigate the association between various vascular disease markers and ED symptoms.
Main Methods:
- The study analyzed 1862 men aged 45-84 without diagnosed cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA).
- Baseline measurements included coronary artery calcium (CAC) score, carotid intima-media thickness, carotid plaque, ankle-brachial index, aortic stiffness, carotid stiffness, and brachial flow-mediated dilation.
- ED symptoms were assessed at MESA visit 5 using a standardized questionnaire, and multivariable logistic regression was employed.
Main Results:
- Of 1862 men, 839 (45%) reported ED symptoms at follow-up.
- Men with ED had a higher prevalence of baseline CAC >100 (36.4% vs 17.2%) and carotid plaque score ≥2 (39% vs 21.1%) compared to those without ED.
- Only CAC >100 (OR: 1.43) and carotid plaque score ≥2 (OR: 1.33) were significantly associated with ED.
Conclusions:
- Subclinical vascular disease is prevalent in men who subsequently report ED.
- Identifying advanced subclinical atherosclerosis, specifically CAC and carotid plaque, can aid in predicting the onset of vascular ED.
Background:
The association between subclinical cardiovascular disease and subsequent development of erectile dysfunction (ED) remains poorly described.
Hypothesis:
Among multiple subclinical atherosclerosis and vascular dysfunction measurements, coronary artery calcium (CAC) score best predicts ED.
Methods:
After excluding participants taking ED medications at baseline, we studied 1862 men age 45 to 84 years free of known cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA) with comprehensive baseline subclinical vascular disease phenotyping and ED status assessed at MESA visit 5 (9.4 ± 0.5 years after baseline) using a standardized question on ED symptoms. Multivariable logistic regression was used to assess the associations between baseline measures of vascular disease (atherosclerosis domain: CAC, carotid intima-media thickness, carotid plaque, ankle-brachial index; vascular stiffness/function domain: aortic stiffness, carotid stiffness, brachial flow-mediated dilation) and ED symptoms at follow-up.
Results:
Mean baseline age was 59.5 ± 9 years, and 839 participants (45%) reported ED symptoms at follow-up. Compared with symptom-free individuals, participants with ED had higher baseline prevalence of CAC score >100 (36.4% vs 17.2%), carotid intima-media thickness Z score >75th percentile (35.3% vs 16.6%), carotid plaque score ≥2 (39% vs 21.1%), carotid distensibility <25th percentile (34.6% vs 17.1%), aortic distensibility <25th percentile (34.2% vs 18.7%), and brachial flow-mediated dilation <25th percentile (28.4% vs 21.3%); all P < 0.01. Only CAC >100 (odds ratio: 1.43, 95% confidence interval: 1.09-1.88) and carotid plaque score ≥2 (odds ratio: 1.33, 95% confidence interval: 1.02-1.73) were significantly associated with ED.
Conclusions:
Subclinical vascular disease is common in men who later self-report ED. Early detection of subclinical atherosclerosis, particularly advanced CAC and carotid plaque, may provide opportunities for predicting the onset of subsequent vascular ED.