Erectile Dysfunction as a Novel Biomarker for the Onset of Cardiometabolic Vascular Disease Risk in the Aging Male: A Systematic Review and Meta-Analysis

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Background and Objectives: Vascular Erectile dysfunction (ED) is considered a sentinel marker for underlying cardiovascular and metabolic disorders. This systematic review and meta-analysis aim to quantify the correlation and 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. Methods: A 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 metaanalysis. Sensitivity analyses, including leave-one-out analysis, and Egger’s test for publication bias, were performed. Findings: The 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). The temporal relationship indicates that ED precedes the onset of CVD by approximately 2 to 5 years. Endothelial dysfunction, a common pathway in ED and CVD, was highlighted through biomarkers such as flowmediated dilation (FMD), nitric oxide (NO) levels, and C-reactive protein (CRP). Limitations: Limitations include heterogeneity among study designs and the potential for residual confounding. Conclusions: ED is a robust predictive biomarker for CVD in aging males, with significant implications for early detection and preventive strategies. Clinical Implications: Clinicians should consider cardiovascular risk assessment in patients presenting with ED to facilitate timely intervention and improve long-term outcomes.