Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA)

David I. Feldman, Miguel Cainzos-Achirica, Kevin Lenuell Billups, Andrew P. Defilippis, Kanchan Chitaley, Philip Greenland, James H. Stein, Matthew J. Budoff, Zeina Dardari, Martin Miner, Roger S Blumenthal, Khurram Nasir, Michael Blaha

Research output: Contribution to journalArticle


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±0.5years 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±9years, 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 >100 (36.4% vs 17.2%), carotid intima-media thickness Z score >75th percentile (35.3% vs 16.6%), carotid plaque score ≥2 (39% vs 21.1%), carotid distensibility 100 (odds ratio: 1.43, 95% confidence interval: 1.09-1.88) and carotid plaque score ≥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.

Original languageEnglish (US)
JournalClinical Cardiology
StateAccepted/In press - 2016


ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Feldman, D. I., Cainzos-Achirica, M., Billups, K. L., Defilippis, A. P., Chitaley, K., Greenland, P., Stein, J. H., Budoff, M. J., Dardari, Z., Miner, M., Blumenthal, R. S., Nasir, K., & Blaha, M. (Accepted/In press). Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA). Clinical Cardiology.