Erectile Dysfunction as a Predictor of Cardiovascular Disease, With Ramy Abou-Ghayda, MD, MPH

A growing body of evidence appears to confirm that erectile dysfunction (ED) is among the earliest clinical markers of systemic vascular disease, according to a recent study from the University Hospitals Urology Institute.1

This discovery is based on the larger Addressing Cardiometabolic Health Inequities by Early PreVEntion in the Great LakEs Region (ACHIEVE GreatER) program, which aims to directly address patient risk factors and social determinants in hypertension, heart failure, and cardiovascular disease. The program is composed of Wayne State University and the Henry Ford Health System in Detroit.2

“Basically, we wanted to see if changing the way we think about healthcare in general, and healthcare delivery more specifically, would positively impact health outcomes,” Ramy Abou-Ghayda, MD, MPH, chief of Transformation and Quality, associate professor of urology, and associate program director at University Hospitals, Case Western Reserve University, told HCPLive in an exclusive interview. “We chose a subject that’s very personal and private, which is erectile dysfunction, because we have a body of evidence showing that people with erectile dysfunction have a high risk of cardiovascular diseases, like stroke, heart attack, or vascular abnormalities.”

Some of the earliest signs of cardiovascular disease are calcium deposits in the smallest blood vessels in the body, such as the penile vasculature. Given that these vessels must dilate to provide blood to the penis and achieve an erection, Abou-Ghayda and colleagues determined ED’s status as a predictor of and a risk factor for future cardiovascular events.1

In conducting the ACHIEVE GreatER study, Abou-Ghayda and colleagues incorporated ED screening as a test case for a reimagining of care delivery. The UH Urology Institute partnered with local barbers and pastors, who helped recruit participants and hosted screening events. This was deliberately aimed to foster conversations about ED and cardiovascular disease by setting them in safe environments.1

A total of 60 men without a history of cardiovascular events who were at elevated risk for cardiovascular disease due to dyslipidemia, kidney disease, smoking, excessive alcohol consumption, or physical inactivity. Each patient took and completed the International Index of Erectile Function-5 (IIEF-5) survey to assess severity and was given a free CAC scan.1

After these tests, each patient received a follow-up phone call to review their results – when indicated, this call connected them with a cardiologist, primary care provider, or urologist, thereby aiming to link together community screening and timely specialty care.1

According to Abou-Ghayda and colleagues, the ACHIEVE GreatER program serves as a proof-of-concept model for the redesign of healthcare models to close equity gaps. Given that men are, on the whole, less likely to proactively seek care, less likely to have a primary care provider, and more likely to be non-adherent to treatment when assigned. This results in later presentations with more advanced disease and, eventually, poorer outcomes.1

“I think that we need to be more comprehensive in our screening and giving these patients questionnaires, explaining to them that everything in health is related,” Abou-Ghayda said. “There is no isolated system. We’re not dealing with silos. Erectile dysfunction is linked to the heart, and the heart is linked to the kidneys – everything is interconnected, and we need to broaden our projection and our way of thinking of these patients.”

Editor’s Note: Abou-Ghayda reports no relevant disclosures.

References

1. Abou-Ghayda R. Community-Based Healthcare Model Shows Great Promise by Using ED as Warning Signal for Cardiovascular Disease. University Hospitals. December 10, 2025. Accessed January 26, 2026. https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2025/12/community-based-healthcare-model-shows-great-promise-by-using-ed-as-warning-signal?utm_source=MMS&utm_medium=Email&utm_campaign=Urology%7CEmail%7CMMS%7Cinnovation_email_fall_2025

2. University Hospitals. Multi-Institutional Effort to Improve the Life Expectancy of High-Risk Individuals. Accessed January 26, 2026. https://www.uhhospitals.org/uh-research/department-research/heart-and-vascular-research/research-areas/achieve-greater#:~:text=ACHIEVE%20GreatER%20Initiative%20Transforms%20Heart,outcomes%20and%20higher%20mortality%20rates