Vascular and Chronological Age in Men With Erectile Dysfunction: A Longitudinal Study

Introduction: Impaired penile color Doppler ultrasound predicts major adverse cardiovascular (CV) events (MACE), particularly in men at low-risk. However, penile color Doppler ultrasound is not recommended in routine clinical checkups. Aim: To evaluate whether the difference between vascular and chronological age (Dage), as derived from the SCORE algorithm, is a predictor of MACE in subjects consulting for erectile dysfunction (ED) independently from other CV risk factors, including penile color Doppler ultrasound parameters. Methods: A consecutive series of 1687 male patients attending the Outpatient Clinic for ED for the first time was retrospectively studied. Among them, the SCORE was applicable in 49.9% (n = 841) men, of whom 87.9% (n = 739) were free from previous MACE and were analyzed. Main Outcome Measures: Vascular age was derived from the SCORE algorithm and the Dage was considered. Information on MACE was obtained through the City of Florence Registry Office. MACE were identified using the International Classification of Diseases, and fatal and nonfatal MACE were coded as 410-414 (ischemic heart disease), 420-429 (other heart diseases), or 798-799 (sudden death from cardiac diseases), 430-434 or 436-438 (cerebrovascular disease), and 440 (peripheral arterial disease). Results: Dage was associated with incident MACE. When dividing the population according to the median age (56 years), family history of CV diseases, and the presence of metabolic syndrome, the association between Dage and MACE was maintained only in low-risk subjects, even after adjusting for confounders [HR = 1.09(1.03-1.16), 1.05(1.01-1.10) and 1.08(1.01-1.16) for younger men, without CV family history or metabolic syndrome, respectively, all P<.05], including penile color Doppler ultrasound parameters. Conclusion: In subjects consulting for ED, Dage is associated with incident MACE, in particular in low-risk men. The prediction of MACE by Dage is independent from other risk factors including penile color Doppler ultrasound parameters, so it can be used as a costless and safe surrogate marker of penile vascular damage. Copyright (C) 2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.