Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
J Sex Med. 2012 Dec;9(12):3227-38. doi: 10.1111/j.1743-6109.2012.02947.x. Epub 2012 Oct 4.
The classification of subjects as low or high cardiovascular (CV) risk is usually performed by risk engines, based upon multivariate prediction algorithms. However, their accuracy in predicting major adverse CV events (MACEs) is lower in high-risk populations as they take into account only conventional risk factors.
To evaluate the accuracy of Progetto Cuore risk engine in predicting MACE in subjects with erectile dysfunction (ED) and to test the role of unconventional CV risk factors, specifically identified for ED.
A consecutive series of 1,233 men (mean age 53.33 ± 9.08 years) attending our outpatient clinic for sexual dysfunction was longitudinally studied for a mean period of 4.4 ± 2.6 years.
Several clinical, biochemical, and instrumental parameters were evaluated. Subjects were classified as high or low risk, according to previously reported ED-specific risk factors.
In the overall population, Progetto Cuore-predicted population survival was not significantly different from the observed one (P = 0.545). Accordingly, receiver operating characteristic (ROC) analysis shows that Progetto Cuore has an accuracy of 0.697 ± 0.037 (P < 0.001) in predicting MACE. Considering subjects at high risk according to ED-specific risk factors, the observed incidence of MACE was significantly higher than the expected for both low educated and patients reporting partner's hypoactive sexual desire (HSD, both <0.05), but not for other described factors. The area under ROC curves of Progetto Cuore for MACE in subjects with low education and reported partner's HSD were 0.659 ± 0.053 (P = 0.008) and 0.550 ± 0.076 (P = 0.570), respectively.
Overall, Progetto Cuore is a proper instrument for evaluating CV risk in ED subjects. However, in ED, other factors such as low education and partner's HSD concur to risk profile. At variance with low education, Progetto Cuore is not accurate enough to predict MACE in subjects with partner's HSD, suggesting that the latter effect is not mediated by conventional risk factors included in the algorithm.
心血管（CV）风险的低风险或高风险分类通常由风险引擎通过基于多变量预测算法进行。然而，在高危人群中，它们预测主要不良 CV 事件（MACE）的准确性较低，因为它们仅考虑了常规风险因素。
评估 Progetto Cuore 风险引擎在预测勃起功能障碍（ED）患者 MACE 中的准确性，并测试专门为 ED 确定的非常规 CV 风险因素的作用。
对连续的 1233 名男性（平均年龄 53.33 ± 9.08 岁）进行前瞻性研究，这些男性在我们的性功能障碍门诊就诊，平均随访时间为 4.4 ± 2.6 年。
评估了多种临床、生化和仪器参数。根据先前报道的 ED 特定危险因素，将受试者分为高风险或低风险。
在整个人群中，Progetto Cuore 预测的人群生存率与观察到的生存率无显著差异（P = 0.545）。因此，接受者操作特征（ROC）分析表明，Progetto Cuore 在预测 MACE 方面的准确性为 0.697 ± 0.037（P < 0.001）。考虑到根据 ED 特定危险因素处于高风险的患者，低教育水平和报告伴侣性欲减退（HSD）的患者的观察到的 MACE 发生率明显高于预期（两者均<0.05），但其他描述的因素则不然。ROC 曲线下面积，Progetto Cuore 在低教育水平和报告伴侣 HSD 的患者中的 MACE 分别为 0.659 ± 0.053（P = 0.008）和 0.550 ± 0.076（P = 0.570）。
总体而言，Progetto Cuore 是评估 ED 患者 CV 风险的合适工具。然而，在 ED 中，其他因素，如低教育水平和伴侣的 HSD，也会影响风险状况。与低教育水平不同，Progetto Cuore 对预测有伴侣 HSD 的患者的 MACE 不够准确，这表明后者的影响不是由算法中包含的常规风险因素介导的。
