{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T22:07:30Z","timestamp":1784585250569,"version":"3.55.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T00:00:00Z","timestamp":1587686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T00:00:00Z","timestamp":1587686400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Erectile dysfunction (ED) is widely considered as an early manifestation of cardiovascular diseases (CVDs), sharing similar risk factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>Assess rates and predictors of developing CVD and\/or hypertension (HTN) over a long-term follow-up period using user-friendly and clinically reliable tools in men presenting with ED but without CVD\/HTN or known vascular risk factors at baseline.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data from 108 patients presenting between 2005 and 2011 with ED were analyzed. All patients were free from CVD and\/or HTN (CVD\/HTN) at baseline. Patients completed the International Index of Erectile Function (IIEF) at baseline and were followed up every 6 months with clinical assessment or phone interview. Kaplan-Meier analyses estimated the probability of developing CVD\/HTN over time. Cox-regression models tested the association between patient baseline characteristics (for example, age, Charlson Comorbidity Index, baseline IIEF-EF, ED severity, alcohol intake, smoking), response to phosphodiesterase type-5 inhibitors (PDE5is), and the risk of developing CVD\/HTN.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of all, 43 (40%) patients showed IIEF-EF scores suggestive of severe ED; 37 (39%) and 59 (61%) were nonresponders and responders to PDE5i, respectively. Median (interquartile range) age was 51 (41, 61) years. Median (interquartile range) follow-up was 95 (86-106) months. Overall, the estimated risk of developing CVD\/HTN was 15% (95% confidence interval [CI]: 9-27) at 10-year assessment. Men with baseline severe ED had a higher risk of developing CVD\/HTN (34%; 95% CI: 17-59, P\u00a0=\u00a0.03) at 10 years than patients with mild to moderate ED (5% [95% CI: 2-14]). At the Cox regression analysis, severe ED (Hazard ratio [HR], 4.62; 95% CI: 1.43, 8.89; P\u00a0=\u00a0.01) and baseline IIEF-EF score (HR, 0.92; 95% CI: 0.86, 0.99; P\u00a0=\u00a0.02) were associated to the risk of CVD\/HTN overtime. Conversely, age and nonresponders to PDE5is (HR, 0.92; 95% CI: 0.32, 2.68; P\u00a0=\u00a0.9) were not associated to a risk of CVD\/HTN over time.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>The use of an easy and user-friendly tool, as the IIEF-EF domain score, would allow to reliably assess which men with ED at first presentation may deserve a different, more specific and detailed cardiologic investigation to prevent inauspicious CV events.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths &amp; Limitations<\/jats:title>\n                  <jats:p>A single-center-based, observational longitudinal study, raising the possibility of selection biases are the main limits.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Patients with severe ED and lower baseline IIEF-EF but no vascular risk factors at first presentation have more than 30% risk of developing CVD\/HTN in 10-year time. Those patients may benefit from medical preventive strategies to lowering the risk of CV events and HTN.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.jsxm.2020.03.012","type":"journal-article","created":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T16:05:51Z","timestamp":1587744351000},"page":"1489-1494","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":29,"title":["Longitudinal Risk of Developing Cardiovascular Diseases in Patients with Erectile Dysfunction\u2014Which Patients Deserve More Attention?"],"prefix":"10.1093","volume":"17","author":[{"given":"Edoardo","family":"Pozzi","sequence":"first","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology , Milan, , Italy"},{"name":"URI , Milan, , Italy"},{"name":"IRCCS Ospedale San Raffaele , Milan, , Italy"},{"name":"Unit of Urology , Milan, , Italy"},{"name":"Universit\u00e0 Vita-Salute San Raffaele , Milan, , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Capogrosso","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology , Milan, , Italy"},{"name":"URI , Milan, , Italy"},{"name":"IRCCS Ospedale San Raffaele , Milan, , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Boeri","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology , Milan, , Italy"},{"name":"URI , Milan, , Italy"},{"name":"IRCCS Ospedale San Raffaele , Milan, , Italy"},{"name":"Dipartimento di Urologia , Milan, , Italy"},{"name":"U.O.C. Urologia , Milan, , Italy"},{"name":"Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, , Italy"},{"name":"Universit\u00e0 degli Studi di Milano , Milan, , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Belladelli","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology , Milan, , Italy"},{"name":"URI , Milan, , Italy"},{"name":"IRCCS Ospedale San Raffaele , Milan, , Italy"},{"name":"Unit of Urology , Milan, , Italy"},{"name":"Universit\u00e0 Vita-Salute San Raffaele , Milan, , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Baudo","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology , Milan, , Italy"},{"name":"URI , Milan, , Italy"},{"name":"IRCCS Ospedale San Raffaele , Milan, , Italy"},{"name":"Unit of Urology , Milan, , Italy"},{"name":"Universit\u00e0 Vita-Salute San Raffaele , Milan, , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2","family":"Schifano","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology , Milan, , Italy"},{"name":"URI , Milan, , Italy"},{"name":"IRCCS Ospedale San Raffaele , Milan, , Italy"},{"name":"Unit of Urology , Milan, , Italy"},{"name":"Universit\u00e0 Vita-Salute San Raffaele , Milan, , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costantino","family":"Abbate","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology , Milan, , Italy"},{"name":"URI , Milan, , Italy"},{"name":"IRCCS Ospedale San Raffaele , Milan, , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Deh\u00f2","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology , Milan, , Italy"},{"name":"URI , Milan, , Italy"},{"name":"IRCCS Ospedale San Raffaele , Milan, , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Montorsi","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology , Milan, , Italy"},{"name":"URI , Milan, , Italy"},{"name":"IRCCS Ospedale San Raffaele , Milan, , Italy"},{"name":"Unit of Urology , Milan, , Italy"},{"name":"Universit\u00e0 Vita-Salute San Raffaele , Milan, , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Salonia","sequence":"additional","affiliation":[{"name":"Division of Experimental Oncology\/Unit of Urology , Milan, , Italy"},{"name":"URI , Milan, , Italy"},{"name":"IRCCS Ospedale San Raffaele , Milan, , Italy"},{"name":"Unit of Urology , Milan, , Italy"},{"name":"Universit\u00e0 Vita-Salute San Raffaele , Milan, , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,4,24]]},"reference":[{"key":"2023011111134395000_bib1","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/S0302-2838(03)00305-1","article-title":"Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease","volume":"44","author":"Montorsi","year":"2003","journal-title":"Eur Urol"},{"key":"2023011111134395000_bib2","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1001\/jama.1993.03510010089036","article-title":"NIH Consensus Conference. 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