Departments of Family Medicine and Urology, Miriam Hospital and Brown University, Providence, RI.
Department of Urology, Rush University, Chicago, Ill.
Am J Med. 2014 Mar;127(3):174-82. doi: 10.1016/j.amjmed.2013.10.013. Epub 2013 Nov 1.
An association between erectile dysfunction and cardiovascular disease has long been recognized, and studies suggest that erectile dysfunction is an independent marker of cardiovascular disease risk. Therefore, assessment and management of erectile dysfunction may help identify and reduce the risk of future cardiovascular events, particularly in younger men. The initial erectile dysfunction evaluation should distinguish between predominantly vasculogenic erectile dysfunction and erectile dysfunction of other etiologies. For men believed to have predominantly vasculogenic erectile dysfunction, we recommend that initial cardiovascular risk stratification be based on the Framingham Risk Score. Management of men with erectile dysfunction who are at low risk for cardiovascular disease should focus on risk-factor control; men at high risk, including those with cardiovascular symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo noninvasive evaluation for subclinical atherosclerosis. A growing body of evidence supports the use of emerging prognostic markers to further understand cardiovascular risk in men with erectile dysfunction, but few markers have been prospectively evaluated in this population. In conclusion, we support cardiovascular risk stratification and risk-factor management in all men with vasculogenic erectile dysfunction.
勃起功能障碍与心血管疾病之间的关联早已被人们所认识，研究表明勃起功能障碍是心血管疾病风险的独立标志物。因此，评估和管理勃起功能障碍可能有助于识别和降低未来心血管事件的风险，尤其是在年轻男性中。勃起功能障碍的初始评估应区分主要血管性勃起功能障碍和其他病因的勃起功能障碍。对于被认为主要患有血管性勃起功能障碍的男性，我们建议根据弗雷明汉风险评分进行初始心血管风险分层。对于心血管疾病风险低的勃起功能障碍男性，管理重点应放在危险因素控制上；对于心血管症状高风险的男性，应将其转介给心脏病专家。中危风险男性应进行亚临床动脉粥样硬化的非侵入性评估。越来越多的证据支持使用新兴的预后标志物来进一步了解勃起功能障碍男性的心血管风险，但在该人群中，很少有标志物进行过前瞻性评估。总之，我们支持对所有患有血管性勃起功能障碍的男性进行心血管风险分层和危险因素管理。
