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      Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA)

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          ABSTRACT

          Background

          The association between subclinical cardiovascular disease and subsequent development of erectile dysfunction ( ED) remains poorly described.

          Hypothesis

          Among multiple subclinical atherosclerosis and vascular dysfunction measurements, coronary artery calcium ( CAC) score best predicts ED.

          Methods

          After excluding participants taking ED medications at baseline, we studied 1862 men age 45 to 84 years free of known cardiovascular disease from the Multi‐Ethnic Study of Atherosclerosis ( MESA) with comprehensive baseline subclinical vascular disease phenotyping and ED status assessed at MESA visit 5 (9.4 ± 0.5 years after baseline) using a standardized question on ED symptoms. Multivariable logistic regression was used to assess the associations between baseline measures of vascular disease (atherosclerosis domain: CAC, carotid intima‐media thickness, carotid plaque, ankle‐brachial index; vascular stiffness/function domain: aortic stiffness, carotid stiffness, brachial flow‐mediated dilation) and ED symptoms at follow‐up.

          Results

          Mean baseline age was 59.5 ± 9 years, and 839 participants (45%) reported ED symptoms at follow‐up. Compared with symptom‐free individuals, participants with ED had higher baseline prevalence of CAC score >100 (36.4% vs 17.2%), carotid intima‐media thickness Z score >75th percentile (35.3% vs 16.6%), carotid plaque score ≥2 (39% vs 21.1%), carotid distensibility <25th percentile (34.6% vs 17.1%), aortic distensibility <25th percentile (34.2% vs 18.7%), and brachial flow‐mediated dilation <25th percentile (28.4% vs 21.3%); all P < 0.01. Only CAC >100 (odds ratio: 1.43, 95% confidence interval: 1.09‐1.88) and carotid plaque score ≥2 (odds ratio: 1.33, 95% confidence interval: 1.02‐1.73) were significantly associated with ED.

          Conclusions

          Subclinical vascular disease is common in men who later self‐report ED. Early detection of subclinical atherosclerosis, particularly advanced CAC and carotid plaque, may provide opportunities for predicting the onset of subsequent vascular ED.

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          Most cited references28

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          Coronary calcium as a predictor of coronary events in four racial or ethnic groups.

          In white populations, computed tomographic measurements of coronary-artery calcium predict coronary heart disease independently of traditional coronary risk factors. However, it is not known whether coronary-artery calcium predicts coronary heart disease in other racial or ethnic groups. We collected data on risk factors and performed scanning for coronary calcium in a population-based sample of 6722 men and women, of whom 38.6% were white, 27.6% were black, 21.9% were Hispanic, and 11.9% were Chinese. The study subjects had no clinical cardiovascular disease at entry and were followed for a median of 3.8 years. There were 162 coronary events, of which 89 were major events (myocardial infarction or death from coronary heart disease). In comparison with participants with no coronary calcium, the adjusted risk of a coronary event was increased by a factor of 7.73 among participants with coronary calcium scores between 101 and 300 and by a factor of 9.67 among participants with scores above 300 (P<0.001 for both comparisons). Among the four racial and ethnic groups, a doubling of the calcium score increased the risk of a major coronary event by 15 to 35% and the risk of any coronary event by 18 to 39%. The areas under the receiver-operating-characteristic curves for the prediction of both major coronary events and any coronary event were higher when the calcium score was added to the standard risk factors. The coronary calcium score is a strong predictor of incident coronary heart disease and provides predictive information beyond that provided by standard risk factors in four major racial and ethnic groups in the United States. No major differences among racial and ethnic groups in the predictive value of calcium scores were detected. Copyright 2008 Massachusetts Medical Society.
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            Calcified coronary artery plaque measurement with cardiac CT in population-based studies: standardized protocol of Multi-Ethnic Study of Atherosclerosis (MESA) and Coronary Artery Risk Development in Young Adults (CARDIA) study.

            Calcified coronary artery plaque, measured at cardiac computed tomography (CT), is a predictor of cardiovascular disease and may play an increasing role in cardiovascular disease risk assessment. The Multi-Ethnic Study of Atherosclerosis (MESA) and the Coronary Artery Risk Development in Young Adults (CARDIA) study of the National Heart, Lung, and Blood Institute are population-based studies in which calcified coronary artery plaque was measured with electron-beam and multi-detector row CT and a standardized protocol in 6814 (MESA) and 3044 (CARDIA study) participants. The studies were approved by the appropriate institutional review board from the study site or agency, and written informed consent was obtained from each participant. Participation in the CT examination was high, image quality was good, and agreement for the presence of calcified plaque was high (kappa = 0.92, MESA; kappa = 0.77, CARDIA study). Extremely high agreement was observed between and within CT image analysts for the presence (kappa > 0.90, all) and amount (intraclass correlation coefficients, >0.99) of calcified plaque. Measurement of calcified coronary artery plaque with cardiac CT is well accepted by participants and can be implemented with consistently high-quality results with a standardized protocol and trained personnel. If predictive value of calcified coronary artery plaque for cardiovascular events proves sufficient to justify screening a segment of the population, then a standardized cardiac CT protocol is feasible and will provide reproducible results for health care providers and the public. (c) RSNA, 2005.
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              Prevalence and risk factors for erectile dysfunction in the US.

              To assess the prevalence of erectile dysfunction and to quantify associations between putative risk factors and erectile dysfunction in the US adult male population. Cross-sectional analysis of data from 2126 adult male participants in the 2001-2002 National Health and Nutrition Examination Survey (NHANES). Erectile dysfunction assessed by a single question during a self-paced, computer-assisted self-interview. These data are nationally representative of the noninstitutionalized adult male population in the US. The overall prevalence of erectile dysfunction in men aged >/=20 years was 18.4% (95% confidence interval [CI], 16.2-20.7), suggesting that erectile dysfunction affects 18 million men (95% CI, 16-20) in the US. The prevalence of erectile dysfunction was highly positively related to age but was also particularly high among men with one or more cardiovascular risk factors, men with hypertension, and men with a history of cardiovascular disease, even after age adjustment. Among men with diabetes, the crude prevalence of erectile dysfunction was 51.3% (95% CI, 41.9-60.7). In multivariable analyses, erectile dysfunction was significantly and independently associated with diabetes, lower attained education, and lack of physical activity. The high prevalence of erectile dysfunction among men with diabetes and hypertension suggests that screening for erectile dysfunction in these patients may be warranted. Physical activity and other measures for the prevention of cardiovascular disease and diabetes may prevent decrease in erectile function.
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                Author and article information

                Journal
                Clin Cardiol
                Clin Cardiol
                10.1002/(ISSN)1932-8737
                CLC
                Clinical Cardiology
                Wiley Periodicals, Inc. (New York )
                0160-9289
                1932-8737
                03 May 2016
                May 2016
                : 39
                : 5 ( doiID: 10.1002/clc.2016.39.issue-5 )
                : 291-298
                Affiliations
                [ 1 ] Ciccarone Center for the Prevention of Heart Disease Johns Hopkins Medical Institutions Baltimore Maryland
                [ 2 ] Welch Center for Prevention, Epidemiology and Clinical Research Johns Hopkins University Baltimore Maryland
                [ 3 ] The James Buchanan Brady Urological Institute The Johns Hopkins Hospital Baltimore Maryland
                [ 4 ] Department of Cardiology, KentuckyOne Health–Jewish Hospital University of Louisville Louisville Kentucky
                [ 5 ] Department of Environmental and Occupational Health Sciences University of Washington Seattle Washington
                [ 6 ] Departments of Medicine and Preventive Medicine Feinberg School of Medicine, Northwestern University Chicago Illinois
                [ 7 ] Cardiovascular Medicine Division University of Wisconsin School of Medicine and Public Health Madison Wisconsin
                [ 8 ] Department of Internal Medicine Division of Cardiology, Harbor‐UCLA Medical Center Torrance California
                [ 9 ] Department of Family Medicine Alpert Medical School of Brown University Providence Rhode Island
                [ 10 ] Center for Healthcare Advancement and Outcomes Baptist Health South Florida Miami Florida
                Author notes
                [*] [* ] Address for correspondence: Michael J. Blaha, MD The Johns Hopkins Hospital Carnegie 565A 600 North Wolfe Street Baltimore, MD 21287 mblaha1@ 123456jhmi.edu
                Author information
                http://orcid.org/0000-0002-8664-7678
                Article
                PMC4879072 PMC4879072 4879072 CLC22530
                10.1002/clc.22530
                4879072
                27145089
                1220a239-1639-4d6c-b639-4b56e0a221e3
                © 2016 Wiley Periodicals, Inc.
                History
                : 04 January 2016
                : 30 January 2016
                Page count
                Pages: 8
                Funding
                Funded by: National Heart, Lung, and Blood Institute
                Award ID: N01‐HC‐95159
                Award ID: N01‐HC‐95160
                Award ID: N01‐HC‐95161
                Award ID: N01‐HC‐95162
                Award ID: N01‐HC‐95163
                Award ID: N01‐HC‐95164
                Award ID: N01‐HC‐95165
                Award ID: N01‐HC‐95166
                Award ID: N01‐HC‐95167
                Award ID: N01‐HC‐95168
                Award ID: N01‐HC‐95169
                Funded by: Spanish Society of Cardiology
                Categories
                Clinical Investigations
                Clinical Investigations
                Custom metadata
                2.0
                clc22530
                May 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:30.04.2019

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