Feldman DI, Cainzos-Achirica M, Billups KL, DeFilippis AP, Chitaley K, Greenland P, Stein JH, Budoff MJ, Dardari Z, Miner M, Blumenthal RS, Nasir K, Blaha MJ. Subclinical vascular disease and subsequent erectile dysfunction: the Multiethnic Study of Atherosclerosis (MESA). Clin Cardiol. 2016 May;39(5):291-8. doi: 10.1002/clc.22530.

BACKGROUND: The association between subclinical cardiovascular disease and subsequent development of erectile dysfunction (ED) remains poorly described.

HYPOTHESIS: Among multiple subclinical atherosclerosis and vascular dysfunction measurements, coronary artery calcium (CAC) score best predicts ED.

METHODS: After excluding participants taking ED medications at baseline, we studied 1862 men age 45 to 84 years free of known cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA) with comprehensive baseline subclinical vascular disease phenotyping and ED status assessed at MESA visit 5 (9.4 ± 0.5 years after baseline) using a standardized question on ED symptoms. Multivariable logistic regression was used to assess the associations between baseline measures of vascular disease (atherosclerosis domain: CAC, carotid intima-media thickness, carotid plaque, ankle-brachial index; vascular stiffness/function domain: aortic stiffness, carotid stiffness, brachial flow-mediated dilation) and ED symptoms at follow-up.

RESULTS: Mean baseline age was 59.5 ± 9 years, and 839 participants (45%) reported ED symptoms at follow-up. Compared with symptom-free individuals, participants with ED had higher baseline prevalence of CAC score greater than 100 (36.4% vs 17.2%), carotid intima-media thickness Z score greater than 75th percentile (35.3% vs 16.6%), carotid plaque score greater than or equal to 2 (39% vs 21.1%), carotid distensibility less than 25th percentile (34.6% vs 17.1%), aortic distensibility less than 25th percentile (34.2% vs 18.7%), and brachial flow-mediated dilation less than 25th percentile (28.4% vs 21.3%); all P less than 0.01. Only CAC greater than 100 (odds ratio: 1.43, 95% confidence interval: 1.09-1.88) and carotid plaque score greater than or equal to 2 (odds ratio: 1.33, 95% confidence interval: 1.02-1.73) were significantly associated with ED.

CONCLUSIONS: Subclinical vascular disease is common in men who later self-report ED. Early detection of subclinical atherosclerosis, particularly advanced CAC and carotid plaque, may provide opportunities for predicting the onset of subsequent vascular ED.

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