Erectile Dysfunction in Peripheral Vascular Disease: Endovascular Revascularization as a Potential Therapeutic Target (original) (raw)
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Coexistence of vasculogenic erectile dysfunction and peripheral artery disease
Journal of Vascular Nursing, 2020
Erectile dysfunction (ED) is the most common sexual problem experienced by men. The incidence increases with age and causes significant negative impacts on self-esteem, intimate relationships, mental health, and may be a powerful prognostic indicator for underlying vascular disease. The purpose of this clinical column is to provide an overview of the pathophysiology, evaluation, and management of vasculogenic ED in a patient with peripheral artery disease. There is very little research focused on the coexistence of these two disease conditions.
International Journal of Clinical Practice, 2013
Erectile dysfunction (ED) and cardiovascular disease (CVD) share risk factors and frequently coexist, with endothelial dysfunction believed to be the pathophysiologic link. ED is common, affecting more than 70% of men with known CVD. In addition, clinical studies have demonstrated that ED in men with no known CVD often precedes a CVD event by 2-5 years. ED severity has been correlated with increasing plaque burden in patients with coronary artery disease. ED is an independent marker of increased CVD risk including all-cause and especially CVD mortality, particularly in men aged 30-60 years. Thus, ED identifies a window of opportunity for CVD risk mitigation. We recommend that a thorough history, physical exam (including visceral adiposity), assessment of ED severity and duration and evaluation including fasting plasma glucose, lipids, resting electrocardiogram, family history, lifestyle factors, serum creatinine (estimated glomerular filtration rate) and albumin: creatinine ratio, and determination of the presence or absence of the metabolic syndrome be performed to characterise cardiovascular risk in all men with ED. Assessment of testosterone levels should also be considered and biomarkers may help to further quantify risk, even though their roles in development of CVD have not been firmly established. Finally, we recommend that a question about ED be included in assessment of CVD risk in all men and be added to CVD risk assessment guidelines. Review criteria We performed a PubMed search for articles pertinent to relationships between erectile dysfunction (ED) and cardiovascular disease (CVD), peripheral arterial disease, stroke, cardiovascular mortality, or all-cause mortality. The evidence-based consensus presented incorporates these articles, published guidelines and the expertise of the multi-specialty author group. Message for the clinic Erectile dysfunction is an independent marker of increased CVD risk, particularly in younger and middle-aged men. A cardiologist or other clinician with relevant expertise plays an important role in evaluating this risk in men with ED, who may have subclinical CVD. Increased recognition of the potential for CVD in men with ED, followed by appropriate preventive or corrective action, can improve and may save lives.
Vascular Erectile Dysfunction and Subclinical Cardiovascular Disease
Current sexual health reports, 2017
We review the recent literature on the hypothesized temporal relationship between subclinical cardiovascular disease (CVD), vascular erectile dysfunction (ED), and clinical CVD. In addition, we combine emerging research with expert consensus guidelines such as The Princeton Consensus III to provide a preventive cardiologist's perspective toward an ideal approach to evaluating and managing CVD and ED risk in patients. Development of ED was found to occur during the progression from subclinical CVD to clinical CVD. A strong association was observed between subclinical CVD as assessed by coronary artery calcium (CAC) and carotid plaque and subsequent ED, providing evidence for the role of subclinical CVD in predicting ED. ED is also identified as a substantial independent risk factor for overt clinical CVD, and ED symptoms may precede CVD symptoms by 2-3 years. Given the body of evidence on the relationship between subclinical CVD, ED, and clinical CVD we recommend that all men wit...
Erectile Dysfunction and Coronary Artery Disease-the Practice Points
2020
Coronary artery disease (CAD) is a leading cause of morbidity and death. Erectile dysfunction (ED) and Coronary artery disease (CAD) share a common pool of risk factors. Risk factors such as Diabetes, Hypertension, smoking and alcohol consumption display a significant co-relation with ED; and these patients are almost three times more likely to have a coronary blockade when compared to those not reporting ED. A complex interplay between Atherosclerosis, Vascular inflammation and endothelial dysfunction mark the pathophysiological cascade that underlies these disorders, with endothelial dysfunction being the major component affecting different vascular beds of various diameters. Endothelial dysfunction plays a key role in the progression of atherosclerosis, contributing to exaggerated intimal proliferation and dysregulation of the inflammatory processes. It has been well studied that patients with ED tend to develop a severe CAD with multiple vessel involvement compared to those with...
Erectile Dysfunction As a Generalized Vascular Dysfunction
Journal of the American Society of Echocardiography, 2006
We hypothesize that generalized vascular dysfunction may be the underlying cause in patients with erectile dysfunction (ED) without atherosclerosis and its major risk factors. Methods: In all, 30 outpatients with ED and 25 healthy volunteers as a control group were enrolled for this study. Aortic stiffness was calculated from data obtained by echocardiographic examination, which was performed using commercially available equipment with a 2.5-to 3.5-MHz transducer. Endothelium-dependent flow-mediated dilation (FMD) of the brachial artery was assessed using a high-resolution ultrasound system with a 10-MHz linear-array vascular transducer. Shear stress and nitroglycerin was used as a stimulus for assessing endotheliumdependent FMD and nonendothelium-dependent dilation of the brachial artery. Results: FMD was significantly decreased in the ED group compared with control group (4.1 ؎ 3.1% vs 9.7 ؎ 3.5%, P < .001). Nonendothelium-dependent dilation was statistically insignificant in patients with ED compared with control subjects (13 ؎ 3.9% vs 15.4 ؎ 3.8%, P ؍ .55). The relationship between ED and FMD was significant (r ؍ ؊0.66, P < .001), whereas no relationship was found between ED and nonendothelium-dependent dilation (r ؍ ؊0.23, P > .05). Aortic strain (3.7 ؎ 2.7% vs 9.5 ؎ 3.2%, P < .001) and distensibility (1.5 ؎ 1.0 vs 4.7 ؎ 2.9 cm 2 .dyne ؊1 .10 ؊3 , P < .001) were found significantly lower in the ED group than in the control group. The relationship between ED and aortic stiffness was also significant (for aortic strain; r ؍ ؊0.62, P < .001 and for aortic distensibility; r ؍ ؊0.60, P < .001). Conclusion: Aortic and brachial artery functions are impaired in men with ED without cardiovascular disease or its major risk factors, indicating a more generalized vascular disease.
Vascular medicine (London, England), 2017
Erectile dysfunction (ED) is associated with cardiovascular disease (CVD) and CVD mortality. However, the relationship between ED and subclinical CVD is less clear. We synthesized the available data on the association of ED and measures of subclinical CVD. We searched multiple databases for published literature on studies examining the association of ED and measures of subclinical CVD across four domains: endothelial dysfunction measured by flow-mediated dilation (FMD), carotid intima-media thickness (cIMT), coronary artery calcification (CAC), and other measures of vascular function such as the ankle-brachial index, toe-brachial index, and pulse wave velocity. We conducted random effects meta-analysis and meta-regression on studies that examined an ED relationship with FMD (15 studies; 2025 participants) and cIMT (12 studies; 1264 participants). ED was associated with a 2.64 percentage-point reduction in FMD compared to those without ED (95% CI: -3.12, -2.15). Persons with ED also ...
The Predictive Value of Arteriogenic Erectile Dysfunction for Coronary Artery Disease in Men
The journal of sexual medicine, 2018
Erectile dysfunction (ED) is assumed to be connected with vascular disease caused by endothelial dysfunction, and characterized by the incapability of the smooth muscle cells lining the arterioles to relax, therefore, inhibit vasodilatation. To assess the predictive value of arteriogenic ED for coronary artery disease in men above the age of 40 years. 75 Patients reporting arteriogenic ED and 25 men with normal erectile function were enrolled in the study. Both patients and controls were subjected to the following investigations: lipid profile, fasting blood sugar, body mass index (BMI), waist circumference, penile duplex study, stress electrocardiography (ECG) test, International Index of Erectile Function (IIEF) Type 5 (Arabic version), and cardiovascular (CV) 10-year risk assessment using Framingham and Prospective Cardiovascular Münster (PROCAM) scoring systems. We compare between the study groups regarding the interpretation of exercise testing. We observed significant increase...
Association Between Erectile Dysfunction and Cardiovascular Disease: A Systematic Review
Chattagram Maa-O-Shishu Hospital Medical College Journal
Erectile Dysfunction (ED) describes the persistent inability to achieve or maintain a penile erection for adequate sexual performance. ED is thought to be a vascular disease affecting more than 70% of men with (Cardiovascular Disease) CVD and sharing a myriad of risk factors like hypertension, smoking, diabetes, obesity, ageing and the metabolic syndrome. Diabetes increases the risk of both ED and CVD with the latter being the leading cause of death. Endothelial dysfunction and its role in the development of atherosclerosis may be the common link between ED, CVD and diabetes. With the current epidemic of type 2 diabetes, diabetes related CVD will increase in tandem. Early identification of this risk group is therefore paramount. Evidence has shown that ED is an independent marker of increased CVD risk and heralds the onset of coronary artery disease, peripheral arterial disease and stroke thereby providing a window of opportunity for risk factor modification. In our paper we shall e...