Background:
In cross sectional studies, erectile dysfunction (ED) and overt clinical cardiovascular disease commonly coexist. However, the temporal relationship between subclinical vascular disease and subsequent identification of ED remains unclear.
Methods:
After excluding participants taking ED medications at baseline, we studied 1,862 asymptomatic men from the Multi-Ethnic Study of Atherosclerosis (MESA) with complete baseline multi-modality subclinical disease phenotyping who underwent ED assessment at MESA visit 5 (9.4 years after baseline). ED was defined by self-report per the single question self-assessment in the Massachusetts Male Aging Study. Using multivariable logistic regression (see figure legend for adjustments), we assessed the relationship between three different categories of baseline subclinical vascular disease with subsequent self-identification of ED. Subclinical vascular disease measures tested were: atherosclerosis: coronary artery calcium [CAC], carotid intima-media thickness [CIMT]; vascular stiffness: aortic distensibility, distensibility coefficient; vascular dysfunction: ankle-brachial index [ABI], flow-mediated dilation [FMD].
Results:
A total of 839 men (45%) self-reported ED 9.4 ± 0.5 years after baseline. The mean age for the study population was 63.9 ± 8.9. There was a graded association between number and severity of subclinical disease abnormalities and ED. Measures of atherosclerosis were most closely associated with ED (see figure). Of the specific subclinical disease measurements, only presence of CAC and CAC>100 retained significance in a fully adjusted model (OR 1.5, 1.2 - 1.9; OR 1.4, 1.1 - 1.9).
Conclusions:
Multiple vascular disease abnormalities tend to cluster in men who later self-report ED. Of the tested subclinical vascular disease domains, markers of subclinical atherosclerosis, in particular CAC, are most closely associated with subsequent ED nearly 10 years after baseline.
Insulin resistance is associated with subclinical vascular disease in humans
