Management of a patient with erectile dysfunction with or without known cardiovascular disease

ESC CardioMed ◽  
2018 ◽  
pp. 1039-1044
Author(s):  
Charalambos Vlachopoulos ◽  
Nikolaos Ioakeimidis ◽  
Dimitris Tousoulis
Keyword(s):  
Cardiovascular Disease ◽  
Erectile Dysfunction ◽  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Risk Estimation ◽  
Subclinical Atherosclerosis ◽  
Intermediate Risk ◽  
Cvd Risk ◽  
Practical Algorithms ◽  
Framingham Risk

Erectile dysfunction (ED) is common in subjects with cardiovascular risk factors and in patients with cardiovascular disease (CVD); it also confers an independent risk for future cardiovascular events. Thus, sexual function should be incorporated into CVD risk assessment for all men. Algorithms for the management of patients with ED have been proposed according to the risk for sexual activity and future cardiovascular events. This chapter recommends that initial cardiovascular risk stratification be based on the SCORE risk estimation tool or Framingham Risk Score. Management of men with ED who are at low risk for CVD should focus on risk factor control; men at high/very high risk, including those with CVD, should be referred to a cardiologist. Intermediate-risk men should undergo non-invasive evaluation for subclinical atherosclerosis and functional CVD status. This chapter provides practical algorithms for the evaluation and management of these patients. The clinical use of biomarkers has the ability to provide the clinician with a tool to gauge residual risk and chart a course for optimal management of the patient with ED. Testosterone and biomarkers of generalized vascular disease serve this purpose specifically in intermediate-risk ED patients even though most of them do not fulfil all the stringent criteria to adequately predict cardiovascular risk in this specific population.

scholarly journals Assessment of cardiovascular risk tools as predictors of cardiovascular disease events in systemic lupus erythematosus

2021 ◽  
Vol 8 (1) ◽  
pp. e000448
Author(s):  
Jagan Sivakumaran ◽  
Paula Harvey ◽  
Ahmed Omar ◽  
Oshrat Tayer-Shifman ◽  
Murray B Urowitz ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Negative Predictive Value ◽  
Risk Score ◽  
Predictive Value ◽  
Framingham Risk Score ◽  
Cvd Risk ◽  
Framingham Risk ◽  
Number Of Patients

BackgroundSLE is an independent risk factor for cardiovascular disease (CVD). This study aimed to determine which among QRISK2, QRISK3, Framingham Risk Score (FRS), modified Framingham Risk Score (mFRS) and SLE Cardiovascular Risk Equation (SLECRE) best predicts CVD.MethodsThis is a single-centre analysis on 1887 patients with SLE followed prospectively according to a standard protocol. Tools’ scores were evaluated against CVD development at/within 10 years for patients with CVD and without CVD. For patients with CVD, the index date for risk score calculation was chosen as close to 10 years prior to CVD event. For patients without CVD, risk scores were calculated as close to 10 years prior to the most recent clinic appointment. Proportions of low-risk (<10%), intermediate-risk (10%–20%) and high-risk (>20%) patients for developing CVD according to each tool were determined, allowing sensitivity, specificity, positive/negative predictive value and concordance (c) statistics analysis.ResultsAmong 1887 patients, 232 CVD events occurred. QRISK2 and FRS, and QRISK3 and mFRS, performed similarly. SLECRE classified the highest number of patients as intermediate and high risk. Sensitivities and specificities were 19% and 93% for QRISK2, 22% and 93% for FRS, 46% and 83% for mFRS, 47% and 78% for QRISK3, and 61% and 64% for SLECRE. Tools were similar in negative predictive value, ranging from 89% (QRISK2) to 92% (SLECRE). FRS and mFRS had the greatest c-statistics (0.73), while QRISK3 and SLECRE had the lowest (0. 67).ConclusionmFRS was superior to FRS and was not outperformed by the QRISK tools. SLECRE had the highest sensitivity but the lowest specificity. mFRS is an SLE-adjusted practical tool with a simple, intuitive scoring system reasonably appropriate for ambulatory settings, with more research needed to develop more accurate CVD risk prediction tools in this population.

scholarly journals Moderate cardiovascular risk factor among Indonesian: do carotid intima-media thickness (CIMT) predict further?

2020 ◽  
Vol 1 (2) ◽  
pp. 38
Author(s):  
Rina Mawarti ◽  
Denny Suwanto ◽  
Johanes Nugroho Eko Putranto ◽  
Djoko Soemantri
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Risk Score ◽  
Management Strategies ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Bivariate Analysis ◽  
Cvd Risk ◽  
Framingham Risk ◽  
The Impact

Determining management strategies in an individual with intermediate cardiovascular risk represent a great challenge. The impact of increased CIMT to improve estimated cardiovascular disease (CVD) risk score in individual at intermediate cardiovascular risk has not yet been fully elucidated. For this reason, we sought to determine the association between CIMT increment and incident of CVD. We conducted a longitudional retrospective cohort study involving 28 patients with intermediate cardiovascular risk (Framingham risk score 10% - 20%). Subjects with criteria fulfillment had their data collected through history taking, physical examination, and CIMT re-measurement using echocardiography. Bivariate analysis with regression logistic showed significant correlation between increased CIMT with CVD event (p=0.016). CIMT measurement is a plausible noninvasive method to predict subclinical cardiovascular disease to further promote more aggressive management.

The prevalence of cardiovascular disease and its risk factors among prostate cancer patients treated with and without androgen deprivation.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 364-364
Author(s):  
Jehonathan H. Pinthus ◽  
Bobby Shayegan ◽  
Laurence Klotz ◽  
D. Robert Siemens ◽  
Patrick P. Luke ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Androgen Deprivation Therapy ◽  
Androgen Deprivation ◽  
Risk Scores ◽  
Cvd Risk ◽  
Framingham Risk

364 Background: Cardiovascular disease (CVD) is the second most common cause of death in prostate cancer (PC) patients, yet the prevalence of CVD and its risk factors have been incompletely described in this population. Androgen deprivation therapy (ADT) is a risk factor for CVD. The objective of this study were to describe the CVD characteristics and risk factors in PC patients and the relationship between CVD risk and how ADT is used in real-world practice. Methods: RADICAL-PC (Role of Androgen Deprivation Therapy in CArdiovascular Disease – A Longitudinal Prostate Cancer Study) is an ongoing prospective cohort study. We recruited 2395 consecutive men (mean age 68 years) with newly diagnosed PC or with a plan to prescribe ADT for the first time. Cardiovascular risk was estimated by calculating Framingham risk scores. A Framingham score >17 (corresponding with a predicted 10-year CVD risk of >30%) was considered high-risk. Multivariable logistic regression was performed with ADT use as the outcome variable and CVD risk factors as the exposures of interest. Results: The prevalence of known CVD for the entire cohort was 22% and 35% had a Framingham risk score >17. Most participants (58%) were current or former smokers; 16% had diabetes; 45% had hypertension and 23% had high blood pressure but had not received a diagnosis of hypertension; 31% were obese (BMI ≥30kg/m2); 24% had low levels of physical activity. There was a positive relationship between each major cardiovascular risk factor and the use of ADT. However, after adjustment for age, education, alcohol use, BMI and time from PC diagnosis to eligibility assessment, these associations were significantly attenuated. Participants in whom ADT was planned had higher Framingham risk scores than those not intending to receive ADT. This risk was abolished after adjustment for confounders. Conclusions: One in three men with PC is at high cardiovascular risk. Men receiving ADT are a priori at higher CVD risk than PC patients whose treatment strategy does not include ADT. These differences are explained by confounding factors. Clinical trial information: NCT03127631.

The Impact of Atherosclerotic Cardiovascular Risk on Graft Failure in Deceased-Donor Renal Transplantation

2021 ◽  
pp. 152692482110246
Author(s):  
Grace Hsu ◽  
Tracy M. Sparkes ◽  
Brent N. Reed ◽  
Stormi E. Gale ◽  
Brian E. Crossley ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Renal Transplant ◽  
Cardiovascular Events ◽  
Graft Failure ◽  
Deceased Donor ◽  
Low Risk ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease

Introduction: Pretransplant cardiovascular risk may be amplified after renal transplant, but little is known about its impact on graft outcomes. Research question: The purpose of this study was to determine if pretransplant cardiovascular risk was associated with graft outcomes. Design: This retrospective study included deceased-donor renal transplant recipients from 2010-2015. Atherosclerotic cardiovascular disease risk for patients without prior disease was calculated and patients were categorized into high (score >20%), intermediate (7.5-20%), and low risk (<7.5%). Patients with and without prior cardiovascular disease were also compared. The main endpoint was graft failure at 3-years post-transplant. Other outcomes included major adverse cardiovascular events, biopsy-proven rejection, and mortality. Results: In patients without prior atherosclerotic cardiovascular disease (N = 115), graft failure rates (4.5% vs 11.3% vs 12.5%; ( P = 0.64) and major adverse cardiovascular events (9.1% vs 13.2% vs 5.0%; P = 0.52) were similar in the high, intermediate, and low risk groups. In those with prior disease (N = 220), rates of primary nonfunction (6.8% vs 1.7%; P = 0.04), major adverse cardiovascular events (7.3% vs 2.6%; P = 0.01), and heart failure (10.9% vs 3.5%; P = 0.02) were higher than those without cardiovascular; rates of major adverse cardiovascular events and heart failure were insignificant after adjusting for age, gender, and race. Other outcomes were not different. Outcomes did not differ based on pretransplant cardiovascular risk. Discussion: Pretransplant atherosclerotic cardiovascular disease was associated with increased early graft failure but similar outcomes at 3-years, suggesting cardiac risk alone should not exclude transplantation.

scholarly journals Meta-analysis of epigenome-wide association studies of carotid intima-media thickness

2021 ◽  
Author(s):  
Eliana Portilla-Fernández ◽  
Shih-Jen Hwang ◽  
Rory Wilson ◽  
Jane Maddock ◽  
W. David Hill ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Dna Methylation ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Association Studies ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness

AbstractCommon carotid intima-media thickness (cIMT) is an index of subclinical atherosclerosis that is associated with ischemic stroke and coronary artery disease (CAD). We undertook a cross-sectional epigenome-wide association study (EWAS) of measures of cIMT in 6400 individuals. Mendelian randomization analysis was applied to investigate the potential causal role of DNA methylation in the link between atherosclerotic cardiovascular risk factors and cIMT or clinical cardiovascular disease. The CpG site cg05575921 was associated with cIMT (beta = −0.0264, p value = 3.5 × 10–8) in the discovery panel and was replicated in replication panel (beta = −0.07, p value = 0.005). This CpG is located at chr5:81649347 in the intron 3 of the aryl hydrocarbon receptor repressor gene (AHRR). Our results indicate that DNA methylation at cg05575921 might be in the pathway between smoking, cIMT and stroke. Moreover, in a region-based analysis, 34 differentially methylated regions (DMRs) were identified of which a DMR upstream of ALOX12 showed the strongest association with cIMT (p value = 1.4 × 10–13). In conclusion, our study suggests that DNA methylation may play a role in the link between cardiovascular risk factors, cIMT and clinical cardiovascular disease.

scholarly journals Cardiovascular Calcification as a Marker of Increased Cardiovascular Risk and a Surrogate for Subclinical Atherosclerosis: Role of Echocardiography

2021 ◽  
Vol 10 (8) ◽  
pp. 1668
Author(s):  
Andrea Faggiano ◽  
Gloria Santangelo ◽  
Stefano Carugo ◽  
Gregg Pressman ◽  
Eugenio Picano ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Cardiac Computed Tomography ◽  
Subclinical Atherosclerosis ◽  
Organ Damage ◽  
Conventional Risk Factor ◽  
Promising Tool ◽  
Ultrasound Evaluation ◽  
The Individual ◽  
Mitral Apparatus

The risk prediction of future cardiovascular events is mainly based on conventional risk factor assessment by validated algorithms, such as the Framingham Risk Score, the Pooled Cohort Equations and the European SCORE Risk Charts. The identification of subclinical atherosclerosis has emerged as a promising tool to refine the individual cardiovascular risk identified by these models, to prognostic stratify asymptomatic individuals and to implement preventive strategies. Several imaging modalities have been proposed for the identification of subclinical organ damage, the main ones being coronary artery calcification scanning by cardiac computed tomography and the two-dimensional ultrasound evaluation of carotid arteries. In this context, echocardiography offers an assessment of cardiac calcifications at different sites, such as the mitral apparatus (including annulus, leaflets and papillary muscles), aortic valve and ascending aorta, findings that are associated with the clinical manifestation of atherosclerotic disease and are predictive of future cardiovascular events. The aim of this paper is to summarize the available evidence on clinical implications of cardiac calcification, review studies that propose semiquantitative ultrasound assessments of cardiac calcifications and evaluate the potential of ultrasound calcium scores for risk stratification and prevention of clinical events.

scholarly journals Association between parents’ socioeconomic conditions and nutritional status during childhood and the risk of cardiovascular disease in their adult offspring: an intergenerational study in south India

2021 ◽  
pp. jech-2020-216261
Author(s):  
Poppy Alice Carson Mallinson ◽  
Bharati Kulkarni ◽  
Santhi Bhogadi ◽  
Sanjay Kinra
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Maternal Nutrition ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Epidemiological Data ◽  
Adult Offspring ◽  
Inverse Association ◽  
Socioeconomic Conditions ◽  
Leg Length

BackgroundSome researchers have suggested that parents’ exposure to poor socioeconomic conditions during childhood can increase their offspring’s risk of cardiovascular disease, primarily through poor maternal nutrition and growth. However, epidemiological data on this association are limited. In an intergenerational cohort from rural India, we examined the association of parental childhood socioeconomic conditions and stature with offspring’s cardiovascular risk, hypothesising an inverse association between the two.MethodsWe analysed data on 3175 adult offspring (aged 18–35 years, 58% men) and their parents from the third wave of the Andhra Pradesh Children and Parents’ Study (2010–12). We used multilevel linear regression to estimate the association of parents’ Standard of Living Index (SLI, an asset-based measure of socioeconomic conditions) in childhood, height and leg length with subclinical atherosclerosis and cardiovascular risk factors in their offspring.ResultsIn multivariable models adjusted for offspring’s socioeconomic conditions in childhood and adulthood, associations (beta coefficients and 95% CIs) of mother’s and father’s childhood SLI (per SD) were −0.00 mm (−0.01, 0.01) and 0.01 mm (−0.00, 0.02) for carotid intima media thickness, −0.17 mm Hg (−0.61, 0.27) and −0.30 mm Hg (−0.78, 0.20) for systolic blood pressure, −0.43 mg/dL (−2.00, 1.15) and −1.07 mg/dL (−2.79, 0.65) for total cholesterol and −0.00mU/L (−0.04, 0.03) and 0.01mU/L (−0.03, 0.04) for log fasting insulin. Results were of similar magnitude for parental height and leg length.ConclusionsOur findings do not support an inverse association between parental childhood socioeconomic conditions or stature and offspring’s risk of cardiovascular disease. Intergenerational socioeconomic influences on cardiovascular risk may be of limited public health significance for this setting.

scholarly journals Added value of cardiovascular calcifications for prediction of recurrent cardiovascular events and cardiovascular interventions in patients with established cardiovascular disease

2021 ◽  
Author(s):  
Cilie C. van ’t Klooster ◽  
◽  
Yolanda van der Graaf ◽  
Hendrik M. Nathoe ◽  
Michiel L. Bots ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Heart Valve ◽  
Cardiovascular Events ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Added Value ◽  
Cvd Risk ◽  
Major Cardiovascular Events ◽  
Cox Proportional Hazards Models ◽  
Cardiovascular Interventions

AbstractThe purpose is to investigate the added prognostic value of coronary artery calcium (CAC), thoracic aortic calcium (TAC), and heart valve calcium scores for prediction of a combined endpoint of recurrent major cardiovascular events and cardiovascular interventions (MACE +) in patients with established cardiovascular disease (CVD). In total, 567 patients with established CVD enrolled in a substudy of the UCC-SMART cohort, entailing cardiovascular CT imaging and calcium scoring, were studied. Five Cox proportional hazards models for prediction of 4-year risk of MACE + were developed; traditional CVD risk predictors only (model I), with addition of CAC (model II), TAC (model III), heart valve calcium (model IV), and all calcium scores (model V). Bootstrapping was performed to account for optimism. During a median follow-up of 3.43 years (IQR 2.28–4.74) 77 events occurred (MACE+). Calibration of predicted versus observed 4-year risk for model I without calcium scores was good, and the c-statistic was 0.65 (95%CI 0.59–0.72). Calibration for models II–V was similar to model I, and c-statistics were 0.67, 0.65, 0.65, and 0.68 for model II, III, IV, and V, respectively. NRIs showed improvement in risk classification by model II (NRI 15.24% (95%CI 0.59–29.39)) and model V (NRI 20.00% (95%CI 5.59–34.92)), but no improvement for models III and IV. In patients with established CVD, addition of the CAC score improved performance of a risk prediction model with classical risk factors for the prediction of the combined endpoint MACE+ . Addition of the TAC or heart valve score did not improve risk predictions.

Abstract P363: Visceral, but Not Subcutaneous Adiposity by Computed Tomography is Associated With Increased Aortic Wall Thickness in Psoriasis Patients

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Jacob W Groenendyk ◽  
Parag Shukla ◽  
Youssef A Elnabawi ◽  
Joshua P Rivers ◽  
Aditya Goyal ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Wall Thickness ◽  
Aortic Wall ◽  
Subclinical Atherosclerosis ◽  
Visceral Adiposity ◽  
Framingham Risk ◽  
High Prevalence ◽  
Multivariable Regression ◽  
Aortic Wall Thickness ◽  
Subcutaneous Adiposity

Introduction: Patients with psoriasis (PSO), an inflammatory skin disease, experience increased cardiovascular disease and obesity. Traditional measures of obesity, such as BMI and waist-to-hip ratio (WHR), do not fully capture the increased cardiovascular risk. Assessment of adipose tissue distribution via CT scan enables characterization of visceral adiposity (VAT) versus subcutaneous adiposity (SAT), which is clinically useful as excess VAT is known to be associated with cardiovascular events. Aortic Wall Thickness (AWT) is a validated measure of subclinical atherosclerosis. However, the relationship between adiposity distribution and AWT is unknown. Hypothesis: We hypothesized that VAT, but not SAT, BMI, or WHR, would be associated with increased AWT in PSO patients. Methods: Consecutive PSO patients (n=164) underwent quantification of VAT and SAT via CT, and AWT via MRI of the descending aorta. Interrelationships were analyzed via multivariable regression. Results: Patients were middle-aged (mean 50.4), predominantly male (56%), and were at low cardiovascular risk (median Framingham risk 3), despite high prevalence of hyperlipidemia (47%). VAT was significantly associated with AWT (β=0.18, p=0.04), SAT, BMI, or WHR did not demonstrate similar association. This association persisted beyond adjustment for SAT, Framingham score, insulin resistance, and systolic BP (β=0.30, p=0.03). Conclusions: Visceral adiposity demonstrated an association with AWT, a marker of early atherosclerosis, whereas subcutaneous adiposity, BMI, and WHR did not. These findings add to a growing body of literature that visceral fat and its assessment may provide incremental data for risk of subclinical CVD.

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