Diagnosis and treatment of erectile dysfunction for reduction of cardiovascular risk

Ajay Nehra, Graham Jackson, Martin Miner, Kevin L. Billups, Arthur L. Burnett, Jacques Buvat, Culley C. Carson, Glenn R. Cunningham, Irwin Goldstein, Andre T. Guay, Geoff Hackett, Robert A. Kloner, John Kostis, Piero Montorsi, Melinda Ramsey, Raymond C. Rosen, Richard Sadovsky, Allen D. Seftel, Charalambos Vlachopoulos, Frederick C W Wu

Research output: Contribution to journalArticle


Purpose: We established erectile dysfunction as an often neglected but valuable marker of cardiovascular risk, particularly in younger men and men with diabetes. We also reviewed 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 erectile dysfunction. Materials and Methods: We performed a PubMed® search for articles and guidelines pertinent to relationships between erectile dysfunction and cardiovascular disease, cardiovascular and all cause mortality, and pharmacotherapies for dyslipidemia and hypertension. The clinical guidance presented incorporates the current literature and the expertise of the multispecialty investigator group. Results: Numerous cardiovascular risk assessment tools exist but risk stratification remains challenging, particularly in patients at low or intermediate short-term risk. Erectile dysfunction has a predictive value for cardiovascular events that is comparable to or better than that of traditional risk factors. Interventional studies support lifestyle changes as a means of improving overall vascular health as well as sexual functioning. Statins, diuretics, β-blockers and renin-angiotensin system modifiers may positively or negatively affect erectile function. Furthermore, the phosphodiesterase type 5 inhibitors used to treat erectile dysfunction may have systemic vascular benefits. Conclusions: Erectile dysfunction treatment should be considered secondary to decreasing cardiovascular risk. However, informed prescribing may prevent worsening sexual function in men receiving pharmacotherapy for dyslipidemia and hypertension. As the first point of medical contact for men with erectile dysfunction symptoms, the primary care physician or urologist has a unique opportunity to identify those who require early intervention to prevent cardiovascular disease.

Original languageEnglish
Pages (from-to)2031-2038
Number of pages8
JournalJournal of Urology
Issue number6
Publication statusPublished - Jun 2013



  • cardiovascular diseases
  • coronary artery disease
  • erectile dysfunction
  • penis
  • risk

ASJC Scopus subject areas

  • Urology

Cite this

Nehra, A., Jackson, G., Miner, M., Billups, K. L., Burnett, A. L., Buvat, J., Carson, C. C., Cunningham, G. R., Goldstein, I., Guay, A. T., Hackett, G., Kloner, R. A., Kostis, J., Montorsi, P., Ramsey, M., Rosen, R. C., Sadovsky, R., Seftel, A. D., Vlachopoulos, C., & Wu, F. C. W. (2013). Diagnosis and treatment of erectile dysfunction for reduction of cardiovascular risk. Journal of Urology, 189(6), 2031-2038. https://doi.org/10.1016/j.juro.2012.12.107