Erectile Dysfunction and Cardiovascular Disease Risk: An Updated 2024 Systematic Review Meta-Analysis of Prospective Studies

Background and ObjectiveVascular Erectile dysfunction (ED) is considered a sentinel marker for underlying cardiovascular and metabolic disorders. This systematic review and meta-analysis aim to quantify the predictive value of ED for cardiometabolic vascular diseases (CVD) in young adults as well as aging males and to explore the temporal relationship between ED onset and the development of these diseases. MethodsA comprehensive search of databases including PubMed, EMBASE, and Cochrane Library was conducted to identify relevant studies. Inclusion criteria were studies assessing the association between ED and CVD, with effect sizes reported as odds ratios (ORs) or hazard ratios (HRs). Data were extracted and pooled using random-effects meta-analysis. Sensitivity analyses, including leave-one-out analysis, and Eggers test for publication bias, were performed. Key Findings and LimitationsO_LIThe pooled analysis of 39 studies revealed a significant association between ED and CVD with an OR of 1.42 (95% CI: 1.28-1.57). C_LIO_LIThe temporal relationship indicates that ED precedes the onset of CVD by approximately 2 to 5 years. C_LIO_LIEndothelial dysfunction, a common pathway in ED and CVD, was highlighted through biomarkers such as flow-mediated dilation (FMD), nitric oxide (NO) levels, and C-reactive protein (CRP). C_LIO_LILimitations include heterogeneity among study designs and the potential for residual confounding. C_LI Conclusions and Clinical ImplicationsED is a robust predictive biomarker for CVD in aging males, with significant implications for early detection and preventive strategies. Clinicians should consider cardiovascular risk assessment in patients presenting with ED to facilitate timely intervention and improve long-term outcomes.