Erectile Dysfunction as a Predictor of Subclinical Atherosclerosis: A Community Health Assessment Using Coronary...

To examine the relationship between erectile dysfunction severity and coronary artery calcium (CAC) burden, including its distribution and potential use as a predictor of elevated calcium scores in a high-risk community.

This cross-sectional, community-based study recruited men aged ≥40 years with ≥1 cardiovascular risk factor. Erectile dysfunction was measured using the International Index of Erectile Function-5 (IIEF-5), while coronary artery calcium scores were obtained using non-contrast computed tomography and were analyzed continuously and categorically using standard thresholds (≥1, ≥10, ≥100, ≥400). Spearman's rank correlation was used to assess the relationship between IIEF-5 scores and CAC.

Among our study participants (mean age 59.7 years), 61.7% reported ED of varying severity. The median coronary artery calcium score was 1.5 (IQR: 0.0-97.2), with 11.7% exhibiting severe plaque burden (>400). A significant inverse correlation was observed between IIEF-5 scores and CAC burden (ρ = -.414, p = .001). Higher ED severity corresponded with an increasing CAC category. An IIEF-5 score ≤21 demonstrated high sensitivity (93.3%) and negative predictive value (95.7%) for identifying individuals with CAC ≥100.

Erectile dysfunction severity tracked closely with coronary plaque burden, supporting its role as a sentinel clinical marker of subclinical atherosclerosis. Community-based sexual health screening may offer a simple and low-cost approach for early identification of individuals at risk for future cardiovascular disease.