Erectile Dysfunction as a Marker Absent From New Cardiovascular Risk Guidelines

Guidelines on cholesterol treatment and cardiovascular risk assessment suggest that men should receive earlier treatment, but do not include low-density lipoprotein (LDL) cholesterol or erectile dysfunction (ED) in risk assessments, notes an editorial on the implications of the new guidelines.

The guidelines published by the American College of Cardiology/American Heart Association allow a comparison of risk based on gender, age, and ethnicity. The risk factors that are used to estimate the 10-year risk for atherosclerotic cardiovascular disease events are gender, age, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure treatment, diabetes, and smoking status.

“The clinical implications of these guidelines are that men with high cholesterol will be treated earlier and more frequently than past guidelines have recommended,” states Stephen L. Kopecky, MD, Professor of Medicine, Division of Cardiovascular Diseases, at the Mayo Clinic in Rochester, MN.

LDL cholesterol is a common target for treatment, but the guidelines do not used it to estimate risk. “The guideline’s risk calculator is user-friendly for both caregiver and patients and points out not only the 10-year risk for an event in all patients, but also, in those under age 60, a lifetime risk for atherosclerotic cardiovascular disease events,” he states.

The lifetime risk can be a helpful motivator in a younger patient. “A 50-year-old white male with total cholesterol of 144 mg/dL, HDL cholesterol of 44 mg/dL, and systolic blood pressure of 148 mm Hg who is not on blood pressure treatment, has no diabetes, but is a smoker may have only a 7.1% 10-year event rate, but his lifetime risk is 50% for a first event,” states Dr Kopecky. “This marked jump in lifetime risk is impressive to patients, and it should be utilized, especially in the younger age group, to help educate and motivate them on the importance of lifestyle and risk factor change.”

One risk marker not mentioned in the guidelines is ED. A male aged 70 or older with ED has a slightly higher incidence of coronary artery disease, however, the incidence rises significantly in younger age groups. “In a male aged 40 to 49 years, the risk of coronary artery disease by incidence per 1,000 person years is 48 times greater than a similar male without ED,” he states, adding that a heart-healthy lifestyle improves ED within 24 months of lifestyle change and risk factor reduction.

Dr Kopecky notes that care should be taken in African American males when starting a statin due to the potential for marked increases in creatine kinase levels.

The risk factors for cardiovascular disease have been shown to be very similar to the risks for other major diseases, including ED, diabetes mellitus, dementia, and lung cancer. Three-quarters of the risk factors for MI and stroke, ED, diabetes, and dementia are the same and specifically center on age, gender, ethnicity, cholesterol, blood pressure, diabetes, tobacco, and body mass index. “When gender is a risk factor in these disease states, male sex increases risk in all,” states Dr Kopecky.
 

The researchers published their editorial in July 11, 2014, issue of Journal of Men’s Health.