Erectile Dysfunction as a Predictor of Subclinical Atherosclerosis: A Community Health Assessment Using Coronary Calcium Scoring in Underserved Cleveland, Ohio.

OBJECTIVE

To examine the relationship between erectile dysfunction severity and coronary artery calcium (CAC) burden, including its distribution and potential use as a predictor of elevated calcium scores in a high-risk community.

METHODS

This cross-sectional, community-based study recruited men aged ≥40 years with ≥1 cardiovascular risk factor. Erectile dysfunction was measured using the International Index of Erectile Function-5 (IIEF-5), while coronary artery calcium scores were obtained using non-contrast computed tomography and were analyzed continuously and categorically using standard thresholds (≥1, ≥10, ≥100, ≥400). Spearman's rank correlation was used to assess the relationship between IIEF-5 scores and CAC.

RESULTS

Among our study participants (mean age 59.7 years), 61.7% reported ED of varying severity. The median coronary artery calcium score was 1.5 (IQR: 0.0-97.2), with 11.7% exhibiting severe plaque burden (>400). A significant inverse correlation was observed between IIEF-5 scores and CAC burden (ρ = -.414, p = .001). Higher ED severity corresponded with an increasing CAC category. An IIEF-5 score ≤21 demonstrated high sensitivity (93.3%) and negative predictive value (95.7%) for identifying individuals with CAC ≥100.

CONCLUSION

Erectile dysfunction severity tracked closely with coronary plaque burden, supporting its role as a sentinel clinical marker of subclinical atherosclerosis. Community-based sexual health screening may offer a simple and low-cost approach for early identification of individuals at risk for future cardiovascular disease.