title: All men with vasculogenic erectile dysfunction require a cardiovascular workup.
abstract: An association between erectile dysfunction and cardiovascular disease has long been recognized, and studies suggest that erectile dysfunction is an independent marker of cardiovascular disease risk. Therefore, assessment and management of erectile dysfunction may help identify and reduce the risk of future cardiovascular events, particularly in younger men. The initial erectile dysfunction evaluation should distinguish between predominantly vasculogenic erectile dysfunction and erectile dysfunction of other etiologies. For men believed to have predominantly vasculogenic erectile dysfunction, we recommend that initial cardiovascular risk stratification be based on the Framingham Risk Score. Management of men with erectile dysfunction who are at low risk for cardiovascular disease should focus on risk-factor control; men at high risk, including those with cardiovascular symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo noninvasive evaluation for subclinical atherosclerosis. A growing body of evidence supports the use of emerging prognostic markers to further understand cardiovascular risk in men with erectile dysfunction, but few markers have been prospectively evaluated in this population. In conclusion, we support cardiovascular risk stratification and risk-factor management in all men with vasculogenic erectile dysfunction.
authors.affiliation: Departments of Family Medicine and Urology, Miriam Hospital and Brown University, Providence, RI. Electronic address: martin_miner@brown.edu.
authors.forename: Martin
authors.initials: M
authors.lastname: Miner
authors.affiliation: Department of Urology, Rush University, Chicago, Ill.
authors.forename: Ajay
authors.initials: A
authors.lastname: Nehra
authors.affiliation: Guy's & St. Thomas Hospital, London, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Jackson
authors.affiliation: Department of Medicine, Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Mass.
authors.forename: Shalender
authors.initials: S
authors.lastname: Bhasin
authors.affiliation: Department of Urologic Surgery, University of Minnesota, Minneapolis; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Md.
authors.forename: Kevin
authors.initials: K
authors.lastname: Billups
authors.affiliation: The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Md.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
authors.affiliation: Centre d'Etude et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique, Lille, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Buvat
authors.affiliation: Department of Surgery, Division of Urologic Surgery, University of North Carolina, Chapel Hill.
authors.forename: Culley
authors.initials: C
authors.lastname: Carson
authors.affiliation: Departments of Medicine, and Molecular & Cellular Biology, Baylor College of Medicine and St. Luke's Episcopal Hospital, Houston, Tex.
authors.forename: Glenn
authors.initials: G
authors.lastname: Cunningham
authors.affiliation: Division of Cardiology, San Francisco General Hospital and University of California, San Francisco, Calif.
authors.forename: Peter
authors.initials: P
authors.lastname: Ganz
authors.affiliation: San Diego Sexual Medicine, Calif.
authors.forename: Irwin
authors.initials: I
authors.lastname: Goldstein
authors.affiliation: Center For Sexual Function/Endocrinology, Lahey Clinic Medical Center, Peabody, Mass, Tufts University School of Medicine, Boston, Mass.
authors.forename: Andre
authors.initials: A
authors.lastname: Guay
authors.affiliation: Good Hope Hospital, Birmingham, UK.
authors.forename: Geoff
authors.initials: G
authors.lastname: Hackett
authors.affiliation: Heart Institute, Good Samaritan Hospital and Keck School of Medicine at University of Southern California, Los Angeles.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kloner
authors.affiliation: Cardiovascular Institute, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: John B
authors.initials: JB
authors.lastname: Kostis
authors.affiliation: Complete Healthcare Communications, Inc., Chadds Ford, Pa.
authors.forename: K Elizabeth
authors.initials: KE
authors.lastname: LaFlamme
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Institute of Cardiology University of Milan, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Montorsi
authors.affiliation: Complete Healthcare Communications, Inc., Chadds Ford, Pa.
authors.forename: Melinda
authors.initials: M
authors.lastname: Ramsey
authors.affiliation: New England Research Institutes, Inc., Watertown, Mass.
authors.forename: Raymond
authors.initials: R
authors.lastname: Rosen
authors.affiliation: Department of Family Medicine, SUNY-Downstate Medical Center, Brooklyn, NY.
authors.forename: Richard
authors.initials: R
authors.lastname: Sadovsky
authors.affiliation: Department of Urology, Cooper University Hospital, Camden, NJ.
authors.forename: Allen
authors.initials: A
authors.lastname: Seftel
authors.affiliation: Division of Urology, Maimonides Medical Center, Brooklyn, NY, and College of Physicians and Surgeons of Columbia University, New York, NY.
authors.forename: Ridwan
authors.initials: R
authors.lastname: Shabsigh
authors.affiliation: 1st Department of Cardiology, Athens Medical School, Athens, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Vlachopoulos
authors.affiliation: Andrology Research Unit, Developmental & Regenerative Biomedicine Research Group, University of Manchester, Manchester Academic Health Science Centre, Manchester Royal Infirmary, UK.
authors.forename: Frederick
authors.initials: F
authors.lastname: Wu
mesh_terms: D055109:Ankle Brachial Index; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D003331:Coronary Vessels / Q000378:metabolism; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D018783:Impotence, Vasculogenic / Q000209:etiology*; D008297:Male; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D002118:Calcium
keywords: Cardiovascular disease; Erectile dysfunction; Evaluation