Erectile dysfunction as a predictor of cardiovascular risk

Evidence is accumulating in favour of a link between erectile dysfunction (ED) and coronary artery disease (CAD). Prevalence of common risk factors for atherosclerosis is similar. ED is frequently found in patients with CAD and shares a similar pathogenic involvement of nitric oxide-pathway leading to impairment of endothelium-dependent vasodilatation (early phase) and structural vascular abnormalities (late phase). Moreover, there is room to consider ED as a marker of early sub-clinical CAD. It is therefore crucial to identify asymptomatic patients with ED who may be at risk of occult CAD. Initial screening may adopt risk assessment office-based approaches to score patient into low, intermediate or high risk of future cardiovascular events. Attention should be drawn to patients at intermediate risk. Targets for the assessment of sub-clinical CAD in this subset of patients should include both obstructive and non-obstructive CAD. Although less investigated, non-obstructive CAD is a more important target to assess since acute myocardial infarction is the result of an acute occlusion of a previously non critical coronary vessel. Several non-invasive tests may add important diagnostic and prognostic information in patients at intermediate coronary risk. Some of these directly assess coronary atherosclerosis burden - such as coronary calcium score by electron beam computed tomography - whereas others, such as carotid intima-media thickness by ultrasound are surrogates of coronary involvement.