勃起功能障碍(ED)和心血管(CV)疾病(CVD)之间的关联早已被认识到,研究表明ED是CVD风险的独立标志。更重要的是,ED是阻塞性和非阻塞性冠状动脉疾病(CAD)的标志物,并且可能揭示无症状男性中存在亚临床CAD。
讨论ED作为亚临床CVD的早期标志物的作用;描述一种量化该负担的方法;并提出一种用于评估和管理患有血管生成性ED的40-60岁男性的CV风险的算法。那些被认为具有最高CV事件风险的人.
对原始文献和专家共识文件进行了全面审查,并将其纳入CV风险背景下ED管理的临床建议中。
ED的评估和管理可能有助于识别和降低未来CV事件的风险。初步评估应区分血管源性ED和其他病因的ED。
对于以血管源性ED为主的男性,我们建议根据2013年美国心脏病学会/美国心脏协会动脉粥样硬化性CV疾病风险评分进行初始CV危险分层.低CVD风险的男性ED患者的管理应侧重于危险因素控制;包括那些有CV症状的人,应该转介给心脏病专家.中危男性应接受亚临床动脉粥样硬化的非侵入性评估。证据支持使用预后标志物,特别是冠状动脉钙评分,进一步了解ED男性的CV风险。
临床医生必须评估每个40岁以上的男性是否患有ED,尤其是那些没有CAD症状和体征的男性。我们支持所有血管源性ED男性的CV风险分层和降低CVD风险因素。矿工M,教区SJ,BillupsKL,etal.勃起功能障碍和亚临床心血管疾病。性医学修订版2018;7:455-463。
An association between erectile dysfunction (ED) and cardiovascular (CV) disease (CVD) has long been recognized, and studies suggest that ED is an independent marker of CVD risk. More significantly, ED is a marker for both obstructive and non-obstructive coronary artery disease (CAD) and may reveal the presence of subclinical CAD in otherwise asymptomatic men.
To discuss the role of ED as an early marker of subclinical CVD; describe an approach to quantifying that burden; and propose an algorithm for the evaluation and management of CV risk in men 40-60 years of age with
vasculogenic ED, those presumed to have the highest risk for a CV event.
A comprehensive review of original literature and expert consensus documents was conducted and incorporated into clinical recommendations for ED management in the context of CV risk.
Assessment and management of ED may help identify and reduce the risk of future CV events. Initial evaluation should distinguish between
vasculogenic ED and ED of other etiologies.
For men with predominantly
vasculogenic ED, we recommend that initial CV risk stratification be based on the 2013 American College of Cardiology/American Heart Association atherosclerotic CV disease risk score. Management of men with ED who are at low risk for CVD should focus on risk factor control; men at high risk, including those with CV symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo non-invasive evaluation for subclinical atherosclerosis. Evidence supports use of a prognostic markers, particularly coronary calcium score, to further understand CV risk in men with ED.
Clinicians must assess the presence or absence of ED in every man >40 years of age, especially those men who are asymptomatic for signs and symptoms of CAD. We support CV risk stratification and CVD risk factor reduction in all men with
vasculogenic ED. Miner M, Parish SJ, Billups KL, et al. Erectile Dysfunction and Subclinical Cardiovascular Disease. Sex Med Rev 2018;7:455-463.