(079) Early Results of Universal Cardiovascular Disease Risk Assessment in Young Men Presenting with ED and/or Low T
Authors: Hubbard L , Patel A , Nasir K , Starke N 
Published: May 2023

Abstract

Introduction
Erectile dysfunction (ED) and low testosterone (low T) are common men’s health issues, affecting ~40 million and 4 million men in the United States, respectively. 1 Typical risk factors for early ED include cardiometabolic risk factors that may be associated with increased risk for premature CVD. Low T levels have also been strongly implicated as an independent risk factor for CVD development and progression. 2 Whether early screening for atherosclerotic disease in younger men with such conditions may identify potentially high-risk individuals for initiation of preventive therapies is unknown.

Objective
To assess the presence and burden of early atherosclerotic disease in young men with ED and/or low testosterone levels

Methods
Our study is a prospective, longitudinal assessment of cardiovascular risk for all men aged 18-55 presenting to a high-volume men’s health center with ED and/or hypogonadal complaints and serum TT &lt;350ng/dL. Exclusion criteria included prior TRT, prior CVD history, or a history of having seen a cardiologist at any point in the past. All men meeting these basic criteria were automatically referred to a preventative cardiologist for cardiac risk assessment. Prior to cardiology evaluation, all patients had assessment of IIEF and AUA questionnaire scores, STOPBANG scores for obstructive sleep apnea (OSA) risk prediction, and serum hormone profile (TT, E2, PRL, FSH, LH). CVD risk assessment included a serum lipid profile, EKG, Coronary Artery Calcium (CAC) score as assessed by CT, carotid Doppler US, and other studies (e.g. echocardiography) as indicated.

Results
Of the first 35 men sent for CVD risk assessment, 15 (43%) patients with a mean age of 40 years (range 23-50) had completed all aspects of CVD risk assessment. Overall, 7/15 (40%) of these young men had a CAC &gt;0, including 2/7 (28%) of men 40 years. Three of the men &gt;40 years (38%) had very high CAC (87 to 138). Carotid US showed clinically significant plaque in 2/15 of the men (13%).

Conclusions
Our initial data suggest that undiagnosed early atherosclerotic disease is not uncommon in young men with ED and/or low T. Typically men 40 years may have a non-zero CAC slightly more often, the finding of increased CVD risk in 63% of such men in our cohort is much higher than the general male population. The presence of severe atherosclerotic disease with high CAC scores in nearly 40% of our cohort aged 40-50 is even more worrisome. While these are early results, they seem to point to a noteworthy increased risk of CVD based on CAC scoring in young men presenting with ED/low T issues. As our prospective data collection continues, we anticipate that information gathered will strengthen the tie between premature atherosclerotic disease and young men with ED/low T. We hope that such data, generated with a simple, universal referral pathway, may help serve as a basis for future guideline-mandated cardiology evaluation in this potentially at-risk patient population.

Disclosure
No