Community-Based Healthcare Model Shows Great Promise by Using ED as Warning Signal for Cardiovascular Disease

Innovations in Urology | Fall 2025

Although erectile dysfunction (ED) and cardiovascular disease (CVD) may seem unrelated, a growing body of evidence shows that ED is often one of the earliest clinical markers of systemic vascular disease, the leading cause of death worldwide. Yet this powerful clinical signal is underused, because ED is still underreported, muted by stigma and by men’s discomfort discussing sexual health.

Ramy Abou Ghayda, MD

This gap is both a challenge and an opportunity. It calls for a novel mindset in men’s health, one that integrates healthcare delivery and care access strategies beyond the traditional clinic walls. At the University Hospitals Urology Institute, transforming that missed signal into an entry point for prevention is exactly the kind of novel health community-embedded approach we’re testing.

“ED in middle-aged and older men could be vasculogenic (arterial) and thus, shares risk factors and mechanisms with atherosclerosis,” explains Hachem Ziadeh, research associate at the UH Urology Institute. “Therefore, the presence of ED can be an early marker of subclinical atherosclerotic disease and is associated with an increased risk of myocardial infarction and stroke.

“To achieve an erection, the arteries supplying the penis must dilate to allow increased blood flow. Just like other arteries in the body, these vessels can become narrowed or stiff over time, making it harder to get or keep an erection. In that sense, ED can be an early warning signal that the arteries elsewhere in the body, including those in the heart, may also be diseased.”

Data suggest that some of the earliest manifestations of CVD are calcium deposits in the smallest vessels in the body, including the penile vasculature. This makes ED both a risk factor for, and a strong predictor of, future cardiovascular events, notes Ramy Abou Ghayda, MD, MHA, MPH, MBA, a urologist at the UH Urology Institute.

Community Outreach as a Healthcare 2.0 Model

To address this risk in a real-world setting, Dr. Ghayda received a National Institutes of Health grant to evaluate CVD risk in men with ED using coronary artery calcium (CAC) scores. The study, completed earlier this year, uses ED not just as a diagnostic clue, but as a practical trigger to reimagine how we deliver care. He presented the findings at the 2025 American Urological Association conference in Las Vegas, and the work has been published¹ in The Gold Journal of Urology.

“This study is part of a larger initiative called ACHIEVE GreatER [Addressing Cardiometabolic Health Inequities by Early PreVEntion in the Great LakEs Region], which is focused on understanding and addressing healthcare inequities in the Midwest,” Dr. Ghayda says. “We set out with two goals: To reinforce the science linking ED and CVD as a practical tool for early risk detection, and to create a replicable blueprint for partnering with trusted community figures in underserved Cleveland neighborhoods to close gaps in health access and outcomes.”

He continues: “Healthcare delivery is failing a certain segment of the population due to socioeconomic barriers, transportation challenges and broader social determinants of health. Many men simply don’t make it into traditional healthcare settings. But they do show up consistently in community spaces where trust already exists, especially barbershops and churches. Our goal was to leverage these trusted environments as care access strategies in a community-based, Healthcare 2.0 model.”

The UH Urology Institute partnered with local barbers and pastors, designated as Community Champions, who helped recruit participants, hosted screening events and created a safe environment for conversations about ED and CVD. These champions enabled UH to bring education, screening and facilitated referrals directly into the neighborhood, transforming barbershops and faith centers into frontline health access points.

The program enrolled 60 men without a prior cardiovascular event who were at elevated risk for CVD due to factors such as smoking, dyslipidemia, kidney disease, excessive alcohol use or physical inactivity. Each participant completed the International Index of Erectile Function-5 (IIEF-5) survey to assess ED severity and underwent a no-cost CAC scan via computed tomography at UH, which is among the few institutions that routinely offer CAC scans at no charge for CVD screening in this context.

Following testing, each participant received a follow-up phone call to review their results. When indicated, they were connected to a cardiologist, primary care provider or urologist, closing the loop between community screening and timely specialty care. In doing so, the project did more than collect data: it built and executed an end-to-end care pathway from community screening to specialty evaluation.

Early Detection, Smarter Delivery, Better Outcomes

“We once again found that ED is strongly associated with higher coronary artery calcium burden in this population,” Dr. Ghayda says. “But equally important, the study offered a blueprint for how to re-engineer healthcare delivery to reduce inequities.

“The most transformative part of this work is not just confirming the biology, it’s showing that we can operationalize ED as a gateway condition to reach high-risk men earlier and move them into appropriate care. By embedding screening and education within trusted community hubs, we created a practical, scalable model to identify high-risk men earlier and connect them to care.”

The project provides a proof-of-concept model for how health systems can redesign healthcare delivery and access strategies to close equity gaps. This is critical because men are less likely than women to have a primary care provider, less likely to proactively seek care, and more likely to be non-adherent when they do engage. As a result, they often present later, with more advanced disease and poorer outcomes.

A community-based, “meet men where they are” strategy reframes ED not just as an isolated sexual health complaint, but as low-barrier conversation starter in trusted community settings. That would create an entry point into comprehensive cardiometabolic risk assessment.

“If we can show the community that we care, and if we are willing to adopt more innovative, community-centric healthcare delivery and care access strategies, we can change the trajectory of disease outcome, especially in underserved neighborhoods,” Dr. Ghayda says. “This is what we mean by Healthcare 2.0 – moving beyond the four walls of the clinic to build patient-centric, relationship-driven models of care.”

“When we engage and empower trusted champions in the community, we change who gets reached, when they are reached, and what their future looks like,” he adds. “What began as a project on ED and calcium scores is now a scalable model for how urology, and, ultimately, all of medicine can reimagine healthcare delivery for men who have been left behind.”

For more information about this study or to explore community-based partnership opportunities, email Dr. Ghayda at ramy.aboughayda@uhhospitals.org

¹Ziadeh H, Badreddine J, Rajan T, Chemali Y, Rhodes S, Beard L, Abou Ghayda R. Erectile Dysfunction as a Predictor of Subclinical Atherosclerosis: A Community Health Assessment Using Coronary Calcium Scoring in Underserved Cleveland, Ohio. Urology. 2025 Nov 8:S0090-4295(25)01265-8. doi: 10.1016/j.urology.2025.10.047. Epub ahead of print. PMID: 41213436.)

Contributing experts:
Ramy Abou Ghayda, MD, MHA, MPH, MBA
Urologist
University Hospitals Urology Institute
Assistant Professor
Case Western Reserve University School of Medicine

Hachem Ziadeh
Research Associate
University Hospitals Urology Institute