title: Vascular and Chronological Age in Men With Erectile Dysfunction: A Longitudinal Study.
abstract: BACKGROUND
  Impaired penile color Doppler ultrasound predicts major adverse cardiovascular (CV) events (MACE), particularly in men at low-risk. However, penile color Doppler ultrasound is not recommended in routine clinical checkups.
  
  
  OBJECTIVE
  To evaluate whether the difference between vascular and chronological age (Δage), as derived from the SCORE algorithm, is a predictor of MACE in subjects consulting for erectile dysfunction (ED) independently from other CV risk factors, including penile color Doppler ultrasound parameters.
  
  
  METHODS
  A consecutive series of 1687 male patients attending the Outpatient Clinic for ED for the first time was retrospectively studied. Among them, the SCORE was applicable in 49.9% (n = 841) men, of whom 87.9% (n = 739) were free from previous MACE and were analyzed.
  
  
  METHODS
  Vascular age was derived from the SCORE algorithm and the Δage was considered. Information on MACE was obtained through the City of Florence Registry Office. MACE were identified using the International Classification of Diseases, and fatal and nonfatal MACE were coded as 410-414 (ischemic heart disease), 420-429 (other heart diseases), or 798-799 (sudden death from cardiac diseases), 430-434 or 436-438 (cerebrovascular disease), and 440 (peripheral arterial disease).
  
  
  RESULTS
  Δage was associated with incident MACE. When dividing the population according to the median age (56 years), family history of CV diseases, and the presence of metabolic syndrome, the association between Δage and MACE was maintained only in low-risk subjects, even after adjusting for confounders [HR = 1.09(1.03-1.16), 1.05(1.01-1.10) and 1.08(1.01-1.16) for younger men, without CV family history or metabolic syndrome, respectively, all P < .05], including penile color Doppler ultrasound parameters.
  
  
  CONCLUSIONS
  In subjects consulting for ED, Δage is associated with incident MACE, in particular in low-risk men. The prediction of MACE by Δage is independent from other risk factors including penile color Doppler ultrasound parameters, so it can be used as a costless and safe surrogate marker of penile vascular damage.
authors.affiliation: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Rastrelli
authors.affiliation: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; Endocrinology Section, Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.affiliation: Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Via delle Oblate 1, 50139 Florence, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.affiliation: Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy. Electronic address: mario.maggi@unifi.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
mesh_terms: D000328:Adult; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007172:Erectile Dysfunction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D008875:Middle Aged; D010413:Penis / Q000098:blood supply*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018615:Ultrasonography, Doppler, Color
chemical_list: D015415:Biomarkers
keywords: Cardiovascular Risk; Erectile Dysfunction; Penile Color Doppler Ultrasound; SCORE Algorithm; Vascular Age