A cohort of nearly 30,000 men evaluated through a screening questionnaire reaffirmed the previous concepts – patients with ED are more likely to suffer from cardiovascular disease. But the study also suggested that it is important to take into account the degree of ED. Authors stated that the greater the severity of ED, the greater the risk of presence of a medical comorbidity in the patient. Degree of ED severity can therefore be used as a prognostic marker for overall health risk, particularly cardiovascular disease risk.

Specific degrees of ischemic coronary disease and their association with ED in male patients were researched in a group of men with an average age of 56. These men underwent coronary angiography for the purpose of documentationof the specificextent of coronary disease in order to compare this with sexual function.

Sexual function was evaluated using an extensive questionnaire focused on sexual desire, erectile function, and ejaculation. A statistically significant correlation was made between ED and the number of coronary vessels involved. Those patients with one-vessel coronary disease were much more likely to achieve erection than those with two- or three-vessel disease.

It is well understood that only a small fraction of men with ED seek treatment. With the positive correlation between ED and cardiovascular risk, this underreporting by male patients to their healthcare providers should be taken seriously. Perhaps all men over a particular age should be screened for the presence of ED, much like the current recommendations for prostate cancer screening. If ED is present, it could be argued that these men should then undergo investigation for underlying subclinical cardiovascular disease. Endothelial dysfunction appears to be the link between the two disease entities. Increased awareness of the association between ED and cardiac disease should lead general practitioners to inquire as to the presence of ED symptoms in their male patients.

An important issue in patients with cardiac risk and ED is the safety of ED treatment. Topics including the risk of sexual activity eliciting a cardiac event and risk of drug interactions were addressed in an algorithm developed by the First Princeton Consensus Panel. They designated patients to low, intermediate, or high risk for the treatment of ED and participation in sexual activity. They support lifestyle interventions in patients with ED, including weight loss and increased physical activity