https://doi.org/10.4081/aiua.2024.12427

Reassessing cardiovascular risk stratification in men with erectile dysfunction

Vol. 96 No. 4 (2024)
Submitted: February 25, 2024
Accepted: June 1, 2024
Published: December 18, 2024
Erectile dysfunction, cardiovascular disease, IV Princeton consensus
Abstract Views: 2
PDF: 1
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

João Lorigo
joaolorigo@gmail.com
https://orcid.org/0000-0001-9585-2609
Centro Hospitalar e universitário de Coimbra, Portugal.
Daniela Gomes
https://orcid.org/0000-0003-4713-1959
Unidade de Saúde Familiar Serra da Lousã, Vilarinho; Faculty of Medicine, University of Coimbra, Portugal.
Ana Rita Ramalho
https://orcid.org/0000-0001-7968-8706
Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine, University of Coimbra, Portugal.
Edgar Silva
https://orcid.org/0000-0002-8612-0147
Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine, University of Coimbra, Portugal.
Patrícia Mendes
https://orcid.org/0000-0003-0014-965X
Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine, University of Coimbra, Portugal.
Arnaldo Figueiredo
https://orcid.org/0000-0002-7157-0081
Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine, University of Coimbra, Portugal.

Background and objectives: Erectile dysfunction (ED) is an independent and strong marker of cardiovascular disease (CVD) risk. The Princeton Consensus aimed to evaluate and manage cardiovascular risk in men with ED and no known cardiovascular disease, focusing on identifying those requiring additional cardiologic work-up. It has recently been updated to the American population demographics, but European recommendations are needed.

Methods: It was developed a cross-sectional investigation including erectile dysfunction patients. Data were collected from hospital registries. Two risk stratification models were employed and compared: Princeton Consensus Criteria (PC) and European Society of Cardiology (ESC) CVD Risk Criteria. The objective was to stress the importance of the changes in IV Princeton Consensus recommendations in stratifying CVD risk in men with erectile dysfunction using a model validated in European men.

Results: A total of 137 patients with ED, with a mean age of 57.1 years old, were included. According to the PC criteria, 39.7% of the patients were “Low Risk”. When using ESC criteria, the proportion of “Low Risk” patients were significantly lower (12%, p < 0.05). Among “Low Risk” patients according to the PC, 52.5% and 20% were classified as High and Very high risk according to ESC criteria, respectively. One myocardial infarction was reported. The patient was classified as “Low Risk” according to the PC, but the ESC criteria categorized him as “high risk”.

Conclusions: PC is less sensitive than ESC recommendations detecting CVD. It raises concerns that Urologists could be overlooking patients with undiagnosed CVD, consequently missing out on opportunities for prevention of major cardiovascular events (MACEs) and premature deaths.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Partin AW, Peters CA, Kavoussi LR, et al. Campbell Walsh Wein Urology: 3-Volume Set. Elsevier; 2020.
Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. 2007; 120:151-7.
Ayta IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int. 1999; 84:50-6.
Braun M, Wassmer G, Klotz T, et al. Epidemiology of erectile dysfunction: results of the “Cologne Male Survey.” Int J Impot Res. 2000; 12:305-311.
Loscalzo J, Fauci AS, Kasper DL, et al. Harrison’s Principles of Internal Medicine, Twenty-First Edition (Vol.1 & Vol.2). McGraw Hill Professional; 2022.
Townsend N, Kazakiewicz D, Lucy Wright F. Epidemiology of cardiovascular disease in Europe. Nat Rev Cardiol . Published online 2022.
Sexual and Reproductive Health. Uroweb - European Association of Urology. [Accessed August 23, 2023] Available from: https://uroweb.org/guidelines/sexual-and-reproductive-health
How To Evaluate Cardiovascular Risk in a Patient With Erectile Dysfunction. American College of Cardiology. [Accessed August 23, 2023] Available from: https://www.acc.org/latest-in-cardiology/articles/2014/07/18/16/01/how-to-evaluate-cardiovascular-risk-in-a-patient-with-erectile-dysfunction
Nehra A, Jackson G, Miner M, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012; 87:766-78.
Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005; 294:2996-3002.
Schouten BW, Bohnen AM, Bosch JL, et al. Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: results from the Krimpen Study. Int J Impot Res. 2008; 20:92-9.
Gazzaruso C, Solerte SB, Pujia A, et al. Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with angiographically proven asymptomatic coronary artery disease: a potential protective role for statins and 5-phosphodiesterase inhibitors. J Am Coll Cardiol. 2008; 51:2040-4.
Araujo AB, Hall SA, Ganz P, et al. Does Erectile Dysfunction Contribute to Cardiovascular Disease Risk Prediction beyond the Framingham Risk Score? J Am Coll Cardiol. 2010; 55:350-6.
Böhm M, Baumhäkel M, Teo K, et al. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assessment Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials. Circulation 2010; 121:1439-46.
Jackson G, Boon N, Eardley I, et al. Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract. 2010; 64:848-57.
David Batty G, Li Q, Czernichow S, et al. Erectile dysfunction and later cardiovascular disease in men with type 2 diabetes: prospective cohort study based on the ADVANCE trial. J Am Coll Cardiol 2010; 56:1908-13.
Dong JY, Zhang YH, Qin LQ. Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol. 2011; 58:1378-85.
Diaconu CC, Manea M, Marcu DR, et al. The erectile dysfunction as a marker of cardiovascular disease: a review. Acta Cardiol 2020; 75:286-292.
Corona G, Rastrelli G, Isidori AM, et al. Erectile dysfunction and cardiovascular risk: a review of current findings. Expert Rev Cardiovasc Ther 2020; 18:155-164.
Yannas D, Frizza F, Vignozzi L, et al. Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Men’s Health? J Clin Med Res. 2021; 10:2221.
Imprialos K, Koutsampasopoulos K, Manolis A, Doumas M. Erectile Dysfunction as a Cardiovascular Risk Factor: Time to Step Up? Curr Vasc Pharmacol 2021; 19:301-312.
Seidu S, Cebrián A, Kunutsor SK, Khunti K. Erectile dysfunction, phosphodiesterase-5 inhibitor use and risk of cardiovascular disease and mortality in people with diabetes: A systematic review and metaanalysis. Prim Care Diabetes 2022; 16:601-613.
Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42:3227-3337.
Kloner RA, Burnett AL, Miner M, et al. Princeton IV consensus guidelines: PDE5 inhibitors and cardiac health. J Sex Med. 2024; 21:90-11.
Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129:S49-S73.
Li D, Li X, Peng E, et al. Do Urologists Really Recognize the Association Between Erectile Dysfunction and Cardiovascular Disease? Sex Med Today 2020; 8:195-204.
SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J. 2021; 42:2439-2454.
Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, et al. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes. 2013; 6:99-109.
Mostafaei H, Mori K, Hajebrahimi S, et al. Association of erectile dysfunction and cardiovascular disease: an umbrella review of systematic reviews and meta-analyses. BJU Int. 2021; 128:3-11.
Gandaglia G, Briganti A, Jackson G, et al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol. 2014; 65:968-978.
Raheem OA, Su JJ, Wilson JR, Hsieh TC. The Association of Erectile Dysfunction and Cardiovascular Disease: A Systematic Critical Review. Am J Mens Health. 2017; 11:552-563.
Erectile Dysfunction (ED) Guideline - American Urological Association. [Accessed August 28, 2023] Available from: https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
Kostis JB, Jackson G, Rosen R, et al. Sexual Dysfunction and Cardiac Risk (the Second Princeton Consensus Conference). Am J Cardiol. 2005; 96:313-21.

How to Cite

Lorigo, J., Gomes, D., Ramalho, A. R., Silva, E., Mendes, P., & Figueiredo, A. (2024). Reassessing cardiovascular risk stratification in men with erectile dysfunction. Archivio Italiano Di Urologia E Andrologia, 96(4). https://doi.org/10.4081/aiua.2024.12427
Copyright (c) 2024 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.