title: Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  The association between subclinical cardiovascular disease and subsequent development of erectile dysfunction (ED) remains poorly described.
  
  
  OBJECTIVE
  Among multiple subclinical atherosclerosis and vascular dysfunction measurements, coronary artery calcium (CAC) score best predicts ED.
  
  
  METHODS
  After excluding participants taking ED medications at baseline, we studied 1862 men age 45 to 84 years free of known cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA) with comprehensive baseline subclinical vascular disease phenotyping and ED status assessed at MESA visit 5 (9.4 ± 0.5 years after baseline) using a standardized question on ED symptoms. Multivariable logistic regression was used to assess the associations between baseline measures of vascular disease (atherosclerosis domain: CAC, carotid intima-media thickness, carotid plaque, ankle-brachial index; vascular stiffness/function domain: aortic stiffness, carotid stiffness, brachial flow-mediated dilation) and ED symptoms at follow-up.
  
  
  RESULTS
  Mean baseline age was 59.5 ± 9 years, and 839 participants (45%) reported ED symptoms at follow-up. Compared with symptom-free individuals, participants with ED had higher baseline prevalence of CAC score >100 (36.4% vs 17.2%), carotid intima-media thickness Z score >75th percentile (35.3% vs 16.6%), carotid plaque score ≥2 (39% vs 21.1%), carotid distensibility <25th percentile (34.6% vs 17.1%), aortic distensibility <25th percentile (34.2% vs 18.7%), and brachial flow-mediated dilation <25th percentile (28.4% vs 21.3%); all P < 0.01. Only CAC >100 (odds ratio: 1.43, 95% confidence interval: 1.09-1.88) and carotid plaque score ≥2 (odds ratio: 1.33, 95% confidence interval: 1.02-1.73) were significantly associated with ED.
  
  
  CONCLUSIONS
  Subclinical vascular disease is common in men who later self-report ED. Early detection of subclinical atherosclerosis, particularly advanced CAC and carotid plaque, may provide opportunities for predicting the onset of subsequent vascular ED.
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: David I
authors.identifier: http://orcid.org/0000-0002-8664-7678
authors.initials: DI
authors.lastname: Feldman
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Miguel
authors.initials: M
authors.lastname: Cainzos-Achirica
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.|The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Billups
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.|Department of Cardiology, KentuckyOne Health-Jewish Hospital, University of Louisville, Louisville, Kentucky.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: DeFilippis
authors.affiliation: Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington.
authors.forename: Kanchan
authors.initials: K
authors.lastname: Chitaley
authors.affiliation: Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.affiliation: Cardiovascular Medicine Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: James H
authors.initials: JH
authors.lastname: Stein
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Dardari
authors.affiliation: Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Martin
authors.initials: M
authors.lastname: Miner
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.|Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, Florida.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D058070:Asymptomatic Diseases; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010410:Penile Erection; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D059289:Vascular Stiffness