Article

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

Saint Catherine University, Minneapolis, Minnesota, United States
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

ABSTRACT

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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    • "Several studies have demonstrated that brachial artery FMD is an independent predictor of cardiovascular events (Green, Jones, Thijssen, Cable, & Atkinson, 2011 ). Brachial artery FMD has been demonstrated to be impaired in patients with ED versus controls (Bhatia et al., 2013; Chiurlia et al., 2005; Kaiser et al., 2004; Lojanapiwat, Weerusawin, & Kuanprasert, 2009; Vlachopoulos et al., 2008 Yavuzgil et al., 2005). Vlachopoulos et al. (2008 reported on multivariate analysis, after adjusting for confounders , brachial artery FMD (per 1% increase; OR = 0.73; 95% CI [0.52, 0.98]; p = .05) "
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    ABSTRACT: Despite strong association between erectile dysfunction (ED) and cardiovascular disease (CVD), there is a paucity of clear clinical guidelines detailing when and how to evaluate for ED in patients with known CVD, or vice versa. This systematic review discuss the role of cardiologists and urologists in the characterization of risk and management of CVD in the setting of ED, as well as contrasting the current evaluation of CVD and ED from the standpoint of published consensus statements. A comprehensive literature review utilizing MEDLINE®, the Cochrane Library® Central Search, and the Web of Science was performed to identify all published peer-reviewed articles in the English language describing ED and CVD across various disciplines. There is strong consensus that men with ED should be considered at high risk of CVD. Available risk assessment tools should be used to stratify the coronary risk score in each patient. The 2012 Princeton III Consensus Conference expanded on existing cardiovascular recommendations, proposing an approach to the evaluation and management of cardiovascular risk in men with ED and no known CVD. This systematic review highlights the similarities and differences of the existing clinical guidelines and recommendations regarding assessment and management of ED and CVD, as well as the pathophysiological linkage between ED and CVD, which may permit physicians, including urologists, to perform opportunistic screening and initiate secondary prophylaxis with regard to cardiovascular risk factors, particularly in young, nondiabetic men with ED.
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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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    • "Tadalafil (Tad) is an inhibitor of the phosphodiesterase-5 (PDE5) enzyme, a class of mild vasoactive drugs developed for treatment of erectile dysfunction (ED) (Feldman et al., 1994 and Laumann et al., 1999). 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 and Kloner and Jarow, 1999). "
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