Impaired brachial artery endothelium-dependent and – independent vasodilation in men with erectile dysfunction and no other clinical CVD

St. Paul Heart Clinic, St. Paul, Minnesota 55102, USA.
Journal of the American College of Cardiology (Impact Factor: 16.5). 01/2004; 43(2):179-84. DOI: 10.1016/j.jacc.2003.07.042
Source: PubMed


The goal of this study was to determine whether patients with vascular erectile dysfunction (ED) and no other clinical cardiovascular disease have structural and functional abnormalities of other vascular beds.
In many ED patients, vascular disease is the major underlying cause. It may be that ED is an early marker of atherosclerosis in patients without clinical cardiovascular disease.
We assessed systemic vascular structure and function in 30 patients with ED and 27 age-matched normal control (NL) subjects. We measured vascular parameters, including: 1) carotid and brachial artery diameters, intima-media thickness, compliance, and distensibility; 2) aortic pulse wave velocity; 3) coronary calcification; and 4) brachial artery endothelium-dependent and -independent vasodilation.
There were no significant differences in baseline demographics, coronary artery risk score, or lipid values between the two groups. Most structural and functional vascular parameters were similar in the ED and NL groups. Brachial artery flow-mediated vasodilation (FMD) (1.3 vs. 2.4%, p = 0.014) and vasodilation to nitroglycerin (NTG) (13.0 vs. 17.8%, p < 0.05) were significantly reduced in ED patients, compared with NL subjects. In addition, there was a significant correlation between FMD and vasodilation to NTG in ED patients (r = 0.59, p < 0.05) but not in NL subjects.
Patients with ED but no clinical cardiovascular disease have a peripheral vascular defect in endothelium-dependent and -independent vasodilation that occurs before the development of other overt functional or structural systemic vascular disease and is independent of other traditional cardiovascular risk factors.

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Available from: Alan J Bank, Mar 13, 2014
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    • "). Blumentals et al., (2004) investigated that vascular endothelial dysfunction is a main cause of ED. Kaiser et al., (2004) found that patients with ED, but not clinical coronary artery disease (CAD), have defects in endothelium-dependent and -independent vasodilation that occurs early before the development of overt vascular disease. In addition, patients with ED have many risk factors associated with CAD, such as smoking, hypertension, diabetes and hyperlipidemia (Feldman et al., 1994 & Kloner and Jarow, 1999). "
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    • "In addition, penile vascular tree seems to be particularly dependent of NO as it participates on arterial dilation to rapidly increase blood flow but also mediates cavernosous sinusoids and venous dilation that represents a crucial step on venoclusive mechanism that assure the obtaining and maintaining of a rigid erection. In several other vascular territories, NO participation on venous side of circulation is minimal or null [67]. "
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    ABSTRACT: Erectile dysfunction (ED) is a common complaint in hypertensive men and can represent a systemic vascular disease, an adverse effect of antihypertensive medication or a frequent concern that may impair drug compliance. ED has been considered an early marker of cardiovascular disease. The connection between both conditions seems to be located in the endothelium, which may become unable to generate the necessary dilatation in penile vascular bed in response to sexual excitement, producing persistent impairment in erection. On the other hand, the real influence of antihypertensive drugs in erectile function still deserves discussion. Therefore, regardless of ED mechanism in hypertension, early diagnosis and correct approach of sexual life represent an important step of cardiovascular evaluation which certainly contributes for a better choice of hypertension treatment, preventing some complications and restoring the quality of life.
    05/2012; 2012:627278. DOI:10.1155/2012/627278
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    • "It is widely demonstrated that ED and generalized atherosclerosis often share the same cardiovascular risk factors, such as smoking, diabetes, hypertension, dyslipidemia , and obesity; moreover, the atherosclerosis process worsens the severity of aED (Virag et al, 1985; Jackson, 1999; Kaiser et al, 2004). In this regard, the results of the present study showed that a low percentage of patients with aED had an isolated penile arterial dysfunction, whereas the vast majority of the patients had a concomitant atherosclerosis in other arterial districts, confirming our previous observations (Vicari et al, 2006). "
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    ABSTRACT: Introduction. Aim of this study was to evaluate whether the blood concentrations of a new immunophenotype of circulating late endothelial progenitor cells (EPCs) and endothelial microparticles (EMPs) varies in patients with arterial erectile dysfunction (aED) and abnormalities in other arterial districts. Materials and methods. To accomplish this, cavernous artery peak systolic velocity (PSV), acceleration time (AT) and intima media-thickness (IMT) were determined after intracavernous administration of alprostadil by echo-color Doppler in 80 consecutive patients (age range: 50-75 years). Fifteen patients had aED alone (group A) and served as controls; 22 had aED plus atheroma plaques and/or increased intima-media thickness of the common carotid artery (group B); 20 had aED plus lower limb artery abnormalities (group C); and 23 had aED plus carotid and lower limb artery abnormalities (group D). EPCs and EMPs blood concentrations were evaluated by flow cytometry. Blood mononuclear cells with the following immunophenotye CD45neg/CD34pos/CD144pos were defined EPCs, whereas CD45neg/CD144pos/Annexin Vpos cells were defined EMPs. Results. Group B and C patients had a similar PSV, AT, and IMT at the level of the cavernous arteries. Their PSV was significantly lower and mean values of AT and IMT significantly higher compared with group A patients. Patients of the group D had a significantly lower PSV and significantly higher AT and IMT compared with all other groups. As far as serum concentrations of EPCs and EMPs, group D patients had a significantly higher EPC and EMP mean values compared with all other groups. Group B and C patients had similar EPCs and EMPs values. Conclusions. This study showed that a more generalized peripheral atherosclerotic process is associated with a more severe penile artery insufficiency and endothelial dysfunction. Moreover, this study confirms the diagnostic reliability of the immunophenotype of EPCs and EMPs chosen in the clinical practice.
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