Do not shy away from sexual function discussion, doctors told

By Piriya Mahendra, MedWire Reporter

Physicians must enquire about erectile dysfunction (ED) symptoms in all men who are older than 30 years or have cardiovascular (CV) risk factors to ascertain their future cardiac risk, say researchers in the American Heart Journal.

Martin Miner (Miriam Hospital, Rhode Island, USA) and team say that all men over the age of 30 years with CV risk factors such as smoking, obesity, family history, and Type 2 diabetes must be asked whether they have ED symptoms in order to detect potential underlying heart disease.

"ED represents an important first step towards heart disease detection and reduction, yet many health care providers and patients assume it's just a sign of old age," said Miner in a press statement.

"So it may not be something that comes up during an annual physical with a younger man who doesn't fit the 'ED' stereotype."

One of the studies included in Miner and team's literature review showed that addition of ED to the Framingham Risk Score only modestly improved the 10-year predictive capacity of the Framingham Risk Score for myocardial infarction or coronary death data in men. But, other epidemiologic studies showed that the predictive value of ED was quite strong in young men.

Indeed, in the Olmstead Country study, men aged 40-49 years with ED had a fiftyfold higher risk for new incident coronary artery disease (CAD) than those without ED.

However, ED had a lower predictive value for CAD in men 70 years and older, at a fivefold increased risk.

A cohort analysis of the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial showed that baseline ED was associated with a significantly increased risk for coronary heart disease and cerebrovascular disease, at hazard ratios of 1.35 and 1.36, respectively.

"We urge physicians to discuss sexual function with the majority of their male patients - including diabetic men of all ages and men over the age of thirty," remarked Miner.

"There may be a 'window of curability' in which we can intervene early and stop the progression of heart disease. Also, it may be possible to someday use ED as a measurement to tell us if preventive interventions for heart disease are working."

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