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. Epub 2016 May 3.

Abstract

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 >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 <25th percentile (34.6% vs 17.1%), aortic distensibility <25th percentile (34.2% vs 18.7%), and brachial flow-mediated dilation <25th percentile (28.4% vs 21.3%); all P < 0.01. Only CAC >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.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ankle Brachial Index
  • Asymptomatic Diseases
  • Carotid Artery Diseases / diagnosis
  • Carotid Artery Diseases / epidemiology*
  • Carotid Artery Diseases / physiopathology
  • Carotid Intima-Media Thickness
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / epidemiology*
  • Coronary Artery Disease / physiopathology
  • Erectile Dysfunction / diagnosis
  • Erectile Dysfunction / epidemiology*
  • Erectile Dysfunction / physiopathology
  • Hemodynamics
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Penile Erection
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Surveys and Questionnaires
  • Time Factors
  • United States / epidemiology
  • Vascular Calcification / diagnosis
  • Vascular Calcification / epidemiology*
  • Vascular Calcification / physiopathology
  • Vascular Stiffness