Understanding the erectile dysfunction-cardiovascular disease connection: clinical and pathophysiological insights.

Introduction: Erectile dysfunction (ED) and cardiovascular disease (CVD) share common pathophysiological mechanisms and molecular pathways, with ED serving as an independent risk factor and prognostic marker for CVD.

Objectives: This review aims to explore the relationship between ED and CVD, analyze their shared pathophysiological mechanisms, and discuss the implications of these findings for clinical practice.

Methods: A comprehensive literature review was conducted using PubMed, MEDLINE, and Web of Science databases, with keywords including "erectile dysfunction," "cardiovascular disease," "endothelial dysfunction," "inflammation," "oxidative stress," "NO/cGMP/PKG signaling pathway," "RhoA/ROCK pathway," and "testosterone deficiency."

Results: The study found a positive correlation between ED and the incidence rate and severity of CVD, with shared mechanisms such as endothelial dysfunction, oxidative stress, and systemic inflammation. Mendelian randomization studies provided evidence of a causal relationship between genetically predicted CVD and ED risk, although reverse causality remains less clear. Early detection of ED may help prevent and manage CVD, with ED serving as a sentinel marker for asymptomatic coronary artery disease. The review also highlighted the potential of combining treatments like phosphodiesterase type 5 inhibitors with rho-associated protein kinase inhibitors or glucagon-like peptide-1 receptor agonists with testosterone therapy to optimize both cardiovascular and sexual outcomes.

Conclusions: Understanding the association between ED and CVD is crucial for improving patients' quality of life and cardiovascular prognosis. Future research should focus on elucidating the mechanistic pathways underlying ED and CVD, validating causal relationships through long-term, multimodal studies, and developing standardized risk algorithms for early intervention. For clinical practice, proactive ED screening in high-risk populations and interdisciplinary collaboration between cardiologists and urologists are essential to prevent CVD progression and enhance patient quality of life.