The relationship of erectile dysfunction and subclinical cardiovascular disease: A systematic review and meta-analysis

Chukwuemeka U. Osondu, Bryan Vo, Ebenezer T. Oni, Michael Blaha, Emir Veledar, Theodore Feldman, Arthur S. Agatston, Khurram Nasir, Ehimen C. Aneni

Research output: Contribution to journalReview article

Abstract

Erectile dysfunction (ED) is associated with cardiovascular disease (CVD) and CVD mortality. However, the relationship between ED and subclinical CVD is less clear. We synthesized the available data on the association of ED and measures of subclinical CVD. We searched multiple databases for published literature on studies examining the association of ED and measures of subclinical CVD across four domains: endothelial dysfunction measured by flow-mediated dilation (FMD), carotid intima–media thickness (cIMT), coronary artery calcification (CAC), and other measures of vascular function such as the ankle–brachial index, toe–brachial index, and pulse wave velocity. We conducted random effects meta-analysis and meta-regression on studies that examined an ED relationship with FMD (15 studies; 2025 participants) and cIMT (12 studies; 1264 participants). ED was associated with a 2.64 percentage-point reduction in FMD compared to those without ED (95% CI: –3.12, −2.15). Persons with ED also had a 0.09-mm (95% CI: 0.06, 0.12) higher cIMT than those without ED. In subgroup meta-analyses, the mean age of the study population, study quality, ED assessment questionnaire (IIEF-5 or IIEF-15), or the publication date did not significantly affect the relationship between ED and cIMT or between ED and FMD. The results for the association of ED and CAC were inconclusive. In conclusion, this study confirms an association between ED and subclinical CVD and may shed additional light on the shared mechanisms between ED and CVD, underscoring the importance of aggressive CVD risk assessment and management in persons with ED.

Original languageEnglish (US)
Pages (from-to)9-20
Number of pages12
JournalVascular Medicine (United Kingdom)
Volume23
Issue number1
DOIs
Publication statusPublished - Feb 1 2018

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Keywords

  • coronary artery calcification
  • endothelial dysfunction
  • erectile dysfunction
  • subclinical cardiovascular disease, carotid intima-media thickness (cIMT)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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