First AD

Second AD

A. The severity of ED does not correlate with the severity of coronary disease.

B. Men with ED, unlike men with CVD, have low testosterone levels.

C. Among more than 9,000 men followed for 7 years after a first CV event, ED conferred a 1.45-fold higher risk of a second event

 It appears that ED is the “tip of a clinical iceberg” as a consequence of the condition’s association with CVD.

 In fact, the worse the ED, the more diffuse the coronary disease.

 Low testosterone is associated not only with ED, but also with metabolic syndrome, diabetes, and CVD.

Most men who have ED come first to their PCP for help. Often, the efferent limb is simply a prescription for sildenafil. The data above suggest that CVD screening and aggressive risk factor reduction should be an integral part of care for men with ED.

 ED is another historical complaint that has critical ramifications for primary care.

1. Gandaglia G, Briganti A, Jackson G, et al.

 A systematic review of the association between erectile dysfunction and cardiovascular disease.

2. Bohm, M., Baumhakel, M., Teo, K. et al. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease 

 The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician.

ED: The Tip of a Clinical Iceberg?

Gregory W. Rutecki, MD