Longitudinal Risk of Developing Cardiovascular Diseases in Patients With Erectile Dysfunction—Which Patients Deserve More Attention?

Edoardo Pozzi, Paolo Capogrosso, Luca Boeri, Federico Belladelli, Andrea Baudo, Nicolò Schifano, Costantino Abbate, Federico Dehò, Francesco Montorsi, Andrea Salonia

Research output: Contribution to journalArticlepeer-review


Background: Erectile dysfunction (ED) is widely considered as an early manifestation of cardiovascular diseases (CVDs), sharing similar risk factors. Aim: Assess rates and predictors of developing CVD and/or hypertension (HTN) over a long-term follow-up period using user-friendly and clinically reliable tools in men presenting with ED but without CVD/HTN or known vascular risk factors at baseline. Methods: Data from 108 patients presenting between 2005 and 2011 with ED were analyzed. All patients were free from CVD and/or HTN (CVD/HTN) at baseline. Patients completed the International Index of Erectile Function (IIEF) at baseline and were followed up every 6 months with clinical assessment or phone interview. Kaplan-Meier analyses estimated the probability of developing CVD/HTN over time. Cox-regression models tested the association between patient baseline characteristics (for example, age, Charlson Comorbidity Index, baseline IIEF-EF, ED severity, alcohol intake, smoking), response to phosphodiesterase type-5 inhibitors (PDE5is), and the risk of developing CVD/HTN. Results: Of all, 43 (40%) patients showed IIEF-EF scores suggestive of severe ED; 37 (39%) and 59 (61%) were nonresponders and responders to PDE5i, respectively. Median (interquartile range) age was 51 (41, 61) years. Median (interquartile range) follow-up was 95 (86-106) months. Overall, the estimated risk of developing CVD/HTN was 15% (95% confidence interval [CI]: 9-27) at 10-year assessment. Men with baseline severe ED had a higher risk of developing CVD/HTN (34%; 95% CI: 17-59, P =.03) at 10 years than patients with mild to moderate ED (5% [95% CI: 2-14]). At the Cox regression analysis, severe ED (Hazard ratio [HR], 4.62; 95% CI: 1.43, 8.89; P =.01) and baseline IIEF-EF score (HR, 0.92; 95% CI: 0.86, 0.99; P =.02) were associated to the risk of CVD/HTN overtime. Conversely, age and nonresponders to PDE5is (HR, 0.92; 95% CI: 0.32, 2.68; P =.9) were not associated to a risk of CVD/HTN over time. Clinical Implications: The use of an easy and user-friendly tool, as the IIEF-EF domain score, would allow to reliably assess which men with ED at first presentation may deserve a different, more specific and detailed cardiologic investigation to prevent inauspicious CV events. Strengths & Limitations: A single-center-based, observational longitudinal study, raising the possibility of selection biases are the main limits. Conclusions: Patients with severe ED and lower baseline IIEF-EF but no vascular risk factors at first presentation have more than 30% risk of developing CVD/HTN in 10-year time. Those patients may benefit from medical preventive strategies to lowering the risk of CV events and HTN. Pozzi E, Capogrosso P, Boeri L, et al. Longitudinal Risk of Developing Cardiovascular Diseases in Patients With Erectile Dysfunction—Which Patients Deserve More Attention?. J Sex Med 2020;17:1489–1494.

Original languageEnglish
Pages (from-to)1489-1494
Number of pages6
JournalJournal of Sexual Medicine
Issue number8
Publication statusPublished - Aug 2020


  • Cardiovascular Disease
  • Erectile Dysfunction
  • Hypertension
  • International Index Erectile Function
  • Sexual Dysfunction

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology
  • Urology


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