Clinical Cardiology

Erectile dysfunction (ED) is a powerful predictor of coronary artery disease (CAD), especially in men <60 years of age.1 Conversely, a high percentage of men with chronic stable CAD have ED.2 ED usually precedes the onset of angina by 2 to 3 years and adverse cardiovascular events by 3 to 5 years, thus allowing time for risk factor modification to delay or prevent major adverse cardiovascular events.3 Despite the abundance of evidence linking these vascular diseases, application of this knowledge to clinical practice has been limited.3 Here, 2 theoretical cases are described with the goal of illustrating clinical practice guidelines to improve the management of patients with ED and CAD.A 44-year-old previously healthy man presented to primary care complaining that “I haven't had sex in 3 months because I can't get an erection.” The patient did not report any cardiovascular symptoms with exercise but admitted to a sedentary lifestyle. The patient's father suffered his first myocardial infarction at 53 years of age. The patient's blood pressure was 128/84 mm Hg. The patient denied any other cardiovascular symptoms or risk factors.The patient is diagnosed with ED, defined as the persistent inability to achieve and maintain an erection adequate for satisfactory sexual intercourse. ED is a cardiac risk factor and independently predicts mortality, primarily as a result of increased cardiovascular mortality (hazard ratio, 1.43).4 ED usually precedes angina by 2 to 3 years and adverse cardiovascular events by 3 to 5 years. A cardiovascular assessment is initiated to define the patient's risk of future cardiovascular events and to guide therapy.Cardiac risk factors are investigated, and risk factor modification is initiated. This patient's body mass index is 24 kg/m2, fasting glucose is 95 mg/dL, and fasting low-density lipoprotein cholesterol is 150 mg/dL. A …