Reassessing Cardiovascular Risk Stratification in Men with Erectile Dysfunction - Beyond the Abstract
In our cross-sectional study involving 137 patients with ED, we aimed to compare the effectiveness of the Princeton Consensus Criteria against the European Society of Cardiology (ESC) CVD Risk Criteria for stratifying cardiovascular risk. The study was conducted at a central hospital in Portugal where all patients referred for the assessment and treatment of ED were included. Data were collected from hospital registries, incorporating demographic variables, medical history, and CVD risk factors. Each patient was assessed for cardiovascular risk using two methods: the Classic Princeton Criteria and the ESC’s SCORE2/SCORE2-OP system. Importantly, every patient was observed by the same experienced andrologist, ensuring consistency in data collection and evaluation.
Our results indicated that 39.7% of patients were classified as "Low Risk" using the Princeton criteria, whereas only 12% were categorized as such under the ESC guidelines (p<0.05). This significant difference raises concerns about the sensitivity of the Princeton Consensus, suggesting that it may underidentify individuals at high risk of CVD. The potential for misclassification could lead to missed opportunities for intervention in high-risk populations. For example, our study documented a case of myocardial infarction in a patient classified as "Low Risk" by the Princeton criteria, yet deemed "High Risk" according to the ESC criteria. This case exemplifies the need for a more stringent assessment framework that accurately reflects cardiovascular risk in men presenting with ED.
Recent literature reveals a concerning shortfall among urologists in adequately assessing cardiovascular risk in patients with erectile dysfunction (ED), with fewer than 50% performing comprehensive evaluations that address both conditions. This gap highlights the urgent need for a more systematic and integrated approach to the management of these patients to improve clinical outcomes. The updated IV Princeton Consensus recommends the incorporation of risk models such as the Framingham Score in the initial evaluation of patients without known cardiovascular disease (CVD), providing a validated framework for more accurate cardiovascular risk assessment. However, there remains a significant lack of guidelines tailored specifically for the European population. By integrating these risk models, clinicians can achieve a more nuanced understanding of individual risk factors, thereby enhancing the identification of patients who may require further cardiology evaluation and intervention.
We firmly believe that it is for the greater good of the patient to first optimize vascular and cardiovascular health rather than solely focus on treating ED.
In summary, our findings support the integration of the ESC recommendations into clinical practice for the assessment of cardiovascular risk in men with ED. The implementation of these revised guidelines is crucial for ensuring timely identification and management of high-risk patients, ultimately reducing adverse cardiovascular events and improving patient care.
Written by: João Lorigo, MD, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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