Reassessing cardiovascular risk stratification in men with erectile dysfunction

Area of Science:

• Cardiology
• Urology
• Preventive Medicine

Background:

• Erectile dysfunction (ED) serves as a significant independent predictor of cardiovascular disease (CVD).
• The Princeton Consensus (PC) provides guidelines for assessing CVD risk in men with ED, but European-specific recommendations are lacking.
• Recent updates to the PC criteria focus on American demographics, necessitating European validation.

Purpose of the Study:

• To evaluate and compare the effectiveness of the Princeton Consensus (PC) criteria versus the European Society of Cardiology (ESC) CVD Risk Criteria in stratifying cardiovascular risk in European men presenting with erectile dysfunction.
• To highlight the importance of updated recommendations for accurately identifying men with ED who require further cardiologic assessment.

Main Methods:

• A cross-sectional study involving 137 male patients with ED was conducted.
• Data were collected from hospital registries.
• Two risk stratification models, PC and ESC CVD Risk Criteria, were applied and compared.

Main Results:

• The PC criteria classified 39.7% of patients as "Low Risk," whereas the ESC criteria identified only 12% as "Low Risk" (p < 0.05).
• A significant proportion of patients deemed "Low Risk" by PC were reclassified as "High" (52.5%) or "Very High" (20%) risk by ESC criteria.
• One case of myocardial infarction occurred in a patient initially classified as "Low Risk" by PC but as "High Risk" by ESC criteria.

Conclusions:

• The ESC criteria demonstrate superior sensitivity in detecting CVD risk among men with ED compared to the PC criteria.
• There is a concern that the PC criteria may lead to underestimation of CVD risk, potentially causing urologists to overlook patients with undiagnosed CVD.
• Failure to identify high-risk individuals could result in missed opportunities for preventing major adverse cardiovascular events (MACEs) and premature mortality.