Diagnosis and Treatment of Erectile Dysfunction for Reduction of Cardiovascular Risk

PURPOSE: Here, we 1) establish erectile dysfunction (ED) as an often neglected but valuable marker of cardiovascular risk, particularly in younger and diabetic men; and 2) review evidence that lifestyle change, combined with informed prescribing of pharmacotherapies used to mitigate cardiovascular risk, can improve overall vascular health and sexual functioning in men with ED. MATERIALS AND METHODS: A PubMed search for articles and guidelines pertinent to relationships between ED and cardiovascular disease (CVD), cardiovascular and all-cause mortality, and pharmacotherapies for dyslipidemia and hypertension was performed. The clinical guidance presented incorporates the current literature and the expertise of the multi-specialty author group. RESULTS: Numerous cardiovascular risk assessment tools exist, but risk stratification remains challenging, particularly for those patients at low or intermediate short-term risk. ED has a predictive value for cardiovascular events that is comparable to or better than traditional risk factors. Interventional studies support lifestyle changes as means of improving overall vascular health as well as sexual functioning. Statins, diuretics, beta blockers, and renin-angiotensin system modifiers may positively or negatively affect erectile function. Furthermore, phosphodiesterase type 5 (PDE5) inhibitors used to treat ED may have systemic vascular benefits. CONCLUSIONS: Treatment of ED should be considered secondary to cardiovascular risk reduction, but informed prescribing may prevent worsening of sexual function in men receiving pharmacotherapy for dyslipidemia and hypertension. As the first point of medical contact for men with ED symptoms, the primary care physician or urologist has a unique opportunity to identify patients who require early intervention to prevent cardiovascular disease.