The Triad: Erectile Dysfunction - Endothelial Dysfunction - Cardiovascular Disease

Abstract

Endothelial dysfunction is an important process in the development of atherosclerotic cardiovascular disease, while it is also a major pathophysiological mechanism underlying vasculogenic erectile dysfunction (ED). Expectedly, these two prevalent disorders are linked also at the clinical level: ED is common in patients with overt and silent coronary artery disease, while ED is increasingly being regarded as the early clinical manifestation of a generalized vascular disease and carries an independent risk for future cardiovascular events. The emerging awareness of ED as a barometer for cardiovascular disease offers a unique opportunity to enhance preventive vascular health in men. Lifestyle and risk factor modification, as well as pharmacologic therapy (both phosphodiesterase type-5 inhibitors and non-ED-targeting drugs), appear to confer additional benefit both in terms of ED treatment and overall cardiovascular risk; this benefit may be related, at least partly, to the improvement of endothelial function and anti-inflammatory effects. The present review identifies pathophysiologic links between endothelial dysfunction, ED and coronary artery disease, presents methodological aspects regarding penile and systemic endothelial function, and discusses the clinical implications in terms of diagnosis of ED, assessment of patient risk, and treatment.

Erectile dysfunction in arterial hypertension

“…After ejaculation, a strong sympathetic stimulus decreases arterial blood flow via activation of phospholipase C and a phosphatidylinositol biphosphate-and inositol triphosphate-triggered increase of intracellular calcium. Thus, besides an intact endocrine system, both an intact neural as well as an intact vascular system is required for a successful and complete erection [4].…”

“…Cardiovascular risk factors such as arterial hypertension lead to increased oxidative stress in the vascular system triggering vascular inflammation, endothelial cell injury, and finally to endothelial dysfunction and atherosclerosis [4,6]. Given the relatively small diameter of the penile artery [1-2 mm, compared to the coronary (3-4 mm) or femoral artery (6-8 mm)] and the fact that increase in arterial blood flow required for erection is comparable to that required by the heart for vigorous exercise [7], it becomes evident that endothelial dysfunction may lead to erectile dysfunction as a very early clinical sign of impaired (penile) arterial blood flow due to vascular disease.…”

Nitric Oxide-Mediated Coronary Flow Regulation in Patients with Coronary Artery Disease: Recent Advances

“…83 According to Böhm et al, 84 erectile dysfunction is a potent predictor of allcause death and the composite of cardiovascular death, MI, and heart failure in men. Vlachopoulos et al 85 summarized the pathophysiologic links between erectile dysfunction, endothelial dysfunction, and CAD.…”

Erectile Dysfunction

“…Vlachopoulos et al [3][4][5] have over several years studied the independent link between ED and cardiovascular disease (CVD) using biomarkers as a means of identifying the men most at risk of a cardiovascular event. Their latest contribution to the expanding and important literature identifies aortic stiffness as a marker of increased cardiovascular risk in men presenting with ED (this issue).…”

“…In this study, they build on previous experience with unfavorable endothelial and inflammatory markers in patients with ED with or without coronary artery disease using aortic stiffness as an independent predictor of all-cause and cardiovascular mortality in patients with hypertension. 4,5,7 Using aortic pulse wave velocity, they independently predicted major cardiovascular events and on long-term follow up demonstrated the usefulness of pulse wave velocity in identifying low-risk patients. Of particular importance was the identification of cardiovascular risk in the young patient in whom cardiovascular risk reduction has the greatest potential benefit.…”