Over the past decade, there has been an increased interest and focus of urologic research on the field of ED. Particular focus has been on ED and its correlation with cardiovascular disease. Many disease states already known to be associated with ED are also associated with cardiovascular disease. These disease states include hypertension, atherosclerosis, diabetes, peripheral vascular disease, obesity, sedentary lifestyle, and myocardial infarction.

The latest research has been aimed at verifying a direct correlation between ED and cardiovascular disease. There has even been suggestion that ED is often the first clinical manifestation of underlying cardiovascular disease in up to 30% of men presenting with erectile dysfunction. If so, it would be increasingly important for men to disclose symptoms of ED to their primary care providers, as ED might represent an opportunity to evaluate these men for cardiovascular disease. Unfortunately, a reported 90% of men with ED do not discuss this information with their primary provider.

It can be speculated that the reason for underreporting ED is due to patients’ embarrassment in addressing sexual issues with a healthcare provider. Other possibilities are that patients believe the issue resolves without intervention, or that ED is just a normal symptom of aging. Doctors caring for these patients may then be missing the opportunity to prevent cardiovascular morbidity and mortality.

The MMAS of the early 1990s opened the door to increased awareness of the correlation between ED and cardiovascular disease.

This study was the first large scale, population-based study investigating ED, revealing that increased prevalence of ED correlated directly with increasing age. The study evaluated 1,290 randomly selected men and found a clinically significant correlation between ED and other medical comorbidities independent of age. These comorbidities included hypertension, hypercholesterolemia, diabetes, and cardiovascular disease. Patients treated for hypertension had a 15% likelihood of also having complete ED and those with cardiac disease had a 39% likelihood of ED.

Schouten recently conducted a longitudinal, population-based study focused specifically on erectile rigidity as an independent indicator for upcoming cardiovascular events. They found that severely reduced erectile rigidity had a hazardratio of 3.8 for the presentation of cardiovascular disease within 6 years. They agreed that a single question focused on the presence of ED should be incorporated into cardiovascular risk assessment in men. They also stated that men presenting only with the complaint of ED should be evaluated for cardiovascular risk