Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Unit of Urology, Università Vita-Salute San Raffaele, Milan, Italy.
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
J Sex Med. 2020 Aug;17(8):1489-1494. doi: 10.1016/j.jsxm.2020.03.012. Epub 2020 Apr 24.
Erectile dysfunction (ED) is widely considered as an early manifestation of cardiovascular diseases (CVDs), sharing similar risk factors.
Assess rates and predictors of developing CVD and/or hypertension (HTN) over a long-term follow-up period using user-friendly and clinically reliable tools in men presenting with ED but without CVD/HTN or known vascular risk factors at baseline.
Data from 108 patients presenting between 2005 and 2011 with ED were analyzed. All patients were free from CVD and/or HTN (CVD/HTN) at baseline. Patients completed the International Index of Erectile Function (IIEF) at baseline and were followed up every 6 months with clinical assessment or phone interview. Kaplan-Meier analyses estimated the probability of developing CVD/HTN over time. Cox-regression models tested the association between patient baseline characteristics (for example, age, Charlson Comorbidity Index, baseline IIEF-EF, ED severity, alcohol intake, smoking), response to phosphodiesterase type-5 inhibitors (PDE5is), and the risk of developing CVD/HTN.
Of all, 43 (40%) patients showed IIEF-EF scores suggestive of severe ED; 37 (39%) and 59 (61%) were nonresponders and responders to PDE5i, respectively. Median (interquartile range) age was 51 (41, 61) years. Median (interquartile range) follow-up was 95 (86-106) months. Overall, the estimated risk of developing CVD/HTN was 15% (95% confidence interval [CI]: 9-27) at 10-year assessment. Men with baseline severe ED had a higher risk of developing CVD/HTN (34%; 95% CI: 17-59, P = .03) at 10 years than patients with mild to moderate ED (5% [95% CI: 2-14]). At the Cox regression analysis, severe ED (Hazard ratio [HR], 4.62; 95% CI: 1.43, 8.89; P = .01) and baseline IIEF-EF score (HR, 0.92; 95% CI: 0.86, 0.99; P = .02) were associated to the risk of CVD/HTN overtime. Conversely, age and nonresponders to PDE5is (HR, 0.92; 95% CI: 0.32, 2.68; P = .9) were not associated to a risk of CVD/HTN over time.
The use of an easy and user-friendly tool, as the IIEF-EF domain score, would allow to reliably assess which men with ED at first presentation may deserve a different, more specific and detailed cardiologic investigation to prevent inauspicious CV events.
STRENGTHS & LIMITATIONS: A single-center-based, observational longitudinal study, raising the possibility of selection biases are the main limits.
Patients with severe ED and lower baseline IIEF-EF but no vascular risk factors at first presentation have more than 30% risk of developing CVD/HTN in 10-year time. Those patients may benefit from medical preventive strategies to lowering the risk of CV events and HTN. Pozzi E, Capogrosso P, Boeri L, et al. Longitudinal Risk of Developing Cardiovascular Diseases in Patients With Erectile Dysfunction-Which Patients Deserve More Attention?. J Sex Med 2020;17:1489-1494.
勃起功能障碍（ED）被广泛认为是心血管疾病（CVDs）的早期表现，具有相似的危险因素。
使用易于使用和临床可靠的工具，评估在基线时没有 CVD/HTN 或已知血管危险因素的情况下出现 ED 的男性在长期随访期间发生 CVD 和/或高血压（HTN）的发生率和预测因素。
分析了 2005 年至 2011 年间出现 ED 的 108 例患者的数据。所有患者在基线时均无 CVD 和/或 HTN（CVD/HTN）。患者在基线时完成了国际勃起功能指数（IIEF），并每 6 个月通过临床评估或电话访谈进行随访。Kaplan-Meier 分析估计了随时间发生 CVD/HTN 的概率。Cox 回归模型测试了患者基线特征（例如年龄、Charlson 合并症指数、基线 IIEF-EF、ED 严重程度、酒精摄入、吸烟）、对磷酸二酯酶 5 抑制剂（PDE5i）的反应与发生 CVD/HTN 的风险之间的关系。
在所有患者中，43 例（40%）患者的 IIEF-EF 评分提示严重 ED；37 例（39%）和 59 例（61%）分别是非反应者和 PDE5i 反应者。中位（四分位距）年龄为 51（41，61）岁。中位（四分位距）随访时间为 95（86，106）个月。总体而言，在 10 年评估时，估计发生 CVD/HTN 的风险为 15%（95%置信区间[CI]：9-27）。基线时患有严重 ED 的男性发生 CVD/HTN 的风险（34%；95%CI：17-59，P=0.03）高于轻度至中度 ED 的患者（5%；95%CI：2-14）。在 Cox 回归分析中，严重 ED（危险比[HR]，4.62；95%CI：1.43，8.89；P=0.01）和基线 IIEF-EF 评分（HR，0.92；95%CI：0.86，0.99；P=0.02）与 CVD/HTN 的风险随时间增加相关。相反，年龄和 PDE5i 无反应者（HR，0.92；95%CI：0.32，2.68；P=0.9）与 CVD/HTN 的风险随时间增加无关。
使用易于使用和用户友好的工具，如 IIEF-EF 域评分，可以可靠地评估首次出现 ED 的男性中哪些人可能需要进行不同的、更具体和详细的心脏检查，以预防不利的心血管事件。
这是一项单中心、观察性纵向研究，存在选择偏倚的可能性，这是主要的局限性。
首次就诊时患有严重 ED 和较低基线 IIEF-EF 但无血管危险因素的患者，在 10 年内发生 CVD/HTN 的风险超过 30%。这些患者可能受益于降低心血管事件和 HTN 风险的医疗预防策略。
