title: Central Haemodynamics and Prediction of Cardiovascular Events in Patients With Erectile Dysfunction.
abstract: BACKGROUND
  We investigated whether central hemodynamics predict major adverse cardiovascular events (MACEs) in erectile dysfunction (ED) patients beyond traditional risk factors.
  
  
  METHODS
  MACEs in relation to aortic pressures and augmentation index (AIx) were analyzed in 398 patients (mean age, 56 years) with ED but without established cardiovascular (CV) disease.
  
  
  RESULTS
  During the mean follow-up period of 6.5 years, a total of 29 (6.5%) MACEs occurred. The adjusted relative risk of MACEs was 1.062 (95% confidence interval (CI), 1.016-1.116) for a 10-mm Hg increase of aortic systolic pressure, 1.119 (95% CI, 1.036-1.155) for a 10-mm Hg increase of aortic pulse pressure (PP), and 1.191 (95% CI, 1.056-1.372) for a 10% absolute increase of AIx. While aortic pressures and AIx did not significantly improve the C-statistic models, the calibration for all indices was satisfactory. Regarding reclassification, the integrated discrimination improvement index (IDI) indicated improvement in risk discrimination of the models that included AIx and aortic PP compared to the reference model in identifying MACEs (IDI = 0.0069; P = 0.024, and IDI = 0.0060; P = 0.036, respectively). The based on categories for 10-year coronary heart disease risk and adapted at 6.5 years overall net reclassification index showed marginal and indicative risk reclassification for AIx (15.7%, P = 0.12) and aortic PP (7.2%, P = 0.20) respectively.
  
  
  CONCLUSIONS
  Our results show for the first time that higher central pressures and AIx are associated with increased risk for a MACE in ED patients without known CV disease. Considering the adverse prognostic role of central hemodynamics on outcomes, the present findings may explain part of the increased CV risk associated with ED.
authors.affiliation: Hypertension and Cardiometabolic and Sexual Health Units, First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Vlachopoulos
authors.affiliation: Hypertension and Cardiometabolic and Sexual Health Units, First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Ioakeimidis
authors.affiliation: Hypertension and Cardiometabolic and Sexual Health Units, First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Rokkas
authors.affiliation: Hypertension and Cardiometabolic and Sexual Health Units, First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Athanassios
authors.initials: A
authors.lastname: Angelis
authors.affiliation: Hypertension and Cardiometabolic and Sexual Health Units, First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Terentes-Printzios
authors.affiliation: Department of Urology, Hippokration Hospital, Athens, Greece.
authors.forename: Zisis
authors.initials: Z
authors.lastname: Kratiras
authors.affiliation: Hypertension and Cardiometabolic and Sexual Health Units, First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Georgakopoulos
authors.affiliation: Hypertension and Cardiometabolic and Sexual Health Units, First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002138:Calibration; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D002496:Central Venous Pressure; D003327:Coronary Disease / Q000150:complications / Q000453:epidemiology; D007172:Erectile Dysfunction / Q000150:complications*; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D011673:Pulsatile Flow; D018570:Risk Assessment; D012307:Risk Factors
keywords: blood pressure; central pressures; erectile dysfunction; hypertension; major adverse cardiovascular events; risk prediction.