Cardiovascular Risk Evaluation for All Men Should Include
Assessment of Sexual Function
Report on Princeton III Meeting on Cardiometabolic Risks and Sexual Health

Assessment of sexual function should be incorporated into cardiovascular risk evaluation for all men, regardless of the presence or absence of known cardiovascular disease, according to Ajay Nehra, MD, lead author of a report by the Princeton Consensus (Expert Panel) Conference, a collaboration of 22 international, multispecialty researchers.

Erectile dysfunction (ED) is a red flag in younger men under age 55 for future cardiac morbidity or mortality – death or disease – for cardiovascular disease (CVD). In some patients, the time window between onset of ED and a cardiovascular event may be two to five years.

“Any man with ED should be considered at a substantially higher increase cardiovascular risk until further testing can be done,” said Nehra, vice chairperson, professor and director of men’s health in the Department of Urology at Rush University Medical Center. “Erectile dysfunction often occurs in the presence of silent, non-symptomatic cardiovascular disease; and hence this is an opportunity for cardiovascular risk reduction.”

The panel recommends that younger men, more than 30 years old who experience ED receive a thorough, noninvasive cardiovascular disease evaluation. As the consensus panel considers all men with ED who are older than 30 to be at increased CVD risk, a thorough noninvasive and, when indicated, invasive evaluation of CVD status is recommended.

They found that younger men who experienced ED were twice as likely to develop cardiovascular disease than men without ED. The highest risk for cardiovascular disease was in younger men.

While controversial, the consensus panel also recommended that testosterone levels be measured in all men diagnosed with organic ED due to an accumulation of recent studies that link low testosterone to ED, CVD and cardiovascular mortality.

“Testosterone levels should be routinely measured. Men with testosterone levels less than 230 have higher risk for all cause and cardiovascular mortality,” Nehra said. In population based studies of 500 or more patients, low testosterone levels have increased mortality level.

These and other recommendations for controlling ED and CVD emerged from the Princeton III Meeting on Cardiometabolic Risks and Sexual Health, held in 2010, that were reported in the August 2012 issue of the Mayo Clinic Proceedings. 

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