Erectile dysfunction and testosterone deficiency as gender-specific markers of cardiometabolic risk in minority and non-minority men: potential role of social determinants

Evaluation of cardiometabolic risk has become vital in the primary prevention of adverse vascular events (coronary artery disease, heart attack, stroke or congestive heart failure), particularly in younger middle-aged men (aged 40–60 years old). To discern the prevalence of events in these men, clinicians often stratify cardiovascular risk and treat according to traditional Framingham risk criteria. The Framingham Risk Score (FRS) is a useful and often used tool for estimating the 10-year risk for myocardial infarction or coronary death of an individual. It is supported by the 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults. The FRS is based on data obtained from the Framingham Heart Study and it incorporates age, gender, total and high-density lipoprotein (HDL) cholesterol, smoking, systolic blood pressure (BP), and use of antihypertensive medications. However, it is important to note that the Framingham study includes few data from patients <40 years of age and few minority patients (African American and Hispanic). Thus, the FRS may not adequately estimate risk in younger patients and minorities. The FRS also lacks some important risk factors (e.g., family history, fasting glucose, testosterone) that should be considered when estimating cardiovascular risk in the man with ED. It is evident that the traditional Framingham risk assigned to intermediate and low-risk men will miss several of these individuals deemed at high “cardiometabolic risk”, also known as residual cardiovascular risk. This review will elaborate the definition of cardiometabolic risk, and apply the use of erectile dysfunction and testosterone deficiency as gender-specific surrogate markers for cardiovascular risk stratification in men in addition to the traditional Framingham-based markers. Lastly, it will examine minority men's health, racial differences and the need to include the role of social determinants in future research studies of cardiovascular risk.