CVD risk factors prevalent in men with erectile dysfunction
The link between erectile dysfunction (ED) and cardiovascular disease is highly topical. Increasingly, GPs are encouraged to carry out formal cardiovascular risk assessment in patients presenting with ED. But what is the likelihood of picking up previously undiagnosed hyperlipidaemia?
This study, in BJU International, looked at 199 consecutive patients attending an ED clinic. The men were asked to complete a symptom score (the International Index of Erectile Function, or IIEF) and give a fasting blood sample for a lipid profile.
The study chose a value of fasting total cholesterol >5.0mmol/l as the threshold for diagnosing hypercholesterolaemia.
Hypercholesterolaemia was diagnosed in 99 (50%) of the study population, 79 of whom were not receiving treatment with a statin and were considered to be newly diagnosed.
Interestingly, 43% of patients in the study had a history of cardiovascular disease, 39% were smokers and 8% had diabetes. Sixty-one per cent of patients had at least one cardiovascular risk factor.
There was no correlation between patient age and cholesterol levels, nor was there any correlation between IIEF scores (ie symptom severity) and cholesterol levels.
While assigning a diagnosis of hypercholesterolaemia to patients at a threshold of 5.0 mmol/l is clearly debatable, this paper does illustrate the prevalence of dyslipidaemia and cardiovascular risk in this patient population. Whether the link with ED is mediated through atherosclerosis or via the impairment of endothelium-derived smooth muscle relaxation seen in hypercholesterolaemia is an area of continuing research.
The prevalence of cardiovascular risk factors in men with ED emphasises the importance of a holistic approach to this condition in primary care, incorporating opportunistic cardiovascular risk assessment.
Smith NJ, Sei CS, Baldo O et al. The prevalence of newly diagnosed hyperlipidaemia in men with erectile dysfunction. BJU Int 2007;100:357-61Reviewer
Dr Jonathan Rees
GPwSI Urology, Bristol