title: Is erectile dysfunction a reliable indicator of general health status in men?
abstract: BACKGROUND
  Erectile dysfunction (ED) is a common risk factor in men and its incidence increases with age. Ageing and older men frequently have comorbidities such as cardiovascular diseases (CVD), diabetes mellitus (DM), hypertension, chronic obstructive pulmonary disease and dyslipidaemia; likewise, they concurrently refer to a clinician for impairments in sexual function, mostly for ED. The association of ED and other organic, multi-organic or even systemic diseases is widely described, with a specific emphasis on the fact that they often share common pathophysiological factors and mechanisms. Thus we reviewed previous reports assessing the role of ED as a sentinel marker of overall men's health.
  
  
  CONCLUSIONS
  ED is considered an important sentinel marker for CVD. Numerous studies have highlighted the predictive role of ED for subsequent CV events in patients with a silent history of coronary artery disease. Indeed, ED might be considered as a clinical manifestation of a generalised vascular disease, and it should provoke clinicians to check for CVDs in those patients complaining of impaired erectile function. This concept appears to be even more important for men with DM, where ED has already been shown to have a significant predictive ability for major vascular complications. Moreover, data from large population-based studies showed that ED is a significant predictor of all-cause mortality, in addition to CV outcomes. The severity of erectile function is assessed with the International Index of Erectile Function-Erectile Function domain score, and this has emerged as a proxy for men's general health status, as assessed with the Charlson Comorbidity Index score.
  
  
  CONCLUSIONS
  Patients complaining of ED should be evaluated with a comprehensive medical and sexual history, and a thorough physical examination, regardless of their age, considering ED as an opportunity to screen for the presence of health-threatening concomitant comorbidities.
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Capogrosso
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Clementi
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Castagna
authors.affiliation: Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
keywords: CAD, coronary artery disease; CCI, Charlson Comorbidity Index; CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; Clinical practice; Comorbidities; DM, diabetes mellitus; ED, erectile dysfunction; EF, erectile function; Erectile dysfunction; HF, heart failure; Health status; IIEF, International Index of Erectile Function; International Index of Erectile Function; MMAS, Massachusetts Male Aging Study; MeS, metabolic syndrome; QoL, quality of life