Erectile dysfunction links to cardiovascular disease—defining the clinical value

Despite many advances over the last few decades, cardiovascular disease (CVD) remains the leading cause of death globally, with men afflicted at an earlier age than women. In a bid to reduce the global burden of morbidity and mortality due to CVD, emphasis has been placed on prevention, particularly on widespread promotion of ideal cardiovascular health behaviors and advancing strategies to identify and treat high-risk individuals who may benefit from aggressive preventive therapy. Erectile dysfunction is a highly prevalent condition that has been demonstrated to share the same risk factors as clinical CVD, and to have independent predictive value for future CVD events. Importantly, subclinical atherosclerosis appears to precede vascular ED by a decade or longer, with ED preceding clinical CVD such as myocardial infarction and stroke in temporal sequence by about 2–5 years. Crucially, since ED may represent the first presentation of otherwise “healthy” men to care providers, a clinical diagnosis of vascular ED may represent a unique opportunity to identify high risk individuals, intervene, and thus prevent progression to clinical CVD. This review summarizes up-to-date evidence of the relationship between ED and subclinical and clinical CVD, and details the position of current guidelines and clinical recommendations on the role of ED assessment in CVD prevention. Finally, this review proposes a clinical framework for the incorporation of ED into standard CVD risk assessment in middle-age men.