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CLINICAL RESEARCH: NON-CARDIAC FINDINGS AND CORONARY ATHEROSCLEROSIS

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

Daniel R. Kaiser, PhD^*, Kevin Billups, MD, Carol Mason, NP^*, Rebecca Wetterling, BS^*, Jennifer L. Lundberg, MS^* and Alan J. Bank, MD, FACC^*,*

^* St. Paul Heart Clinic, St. Paul, USA
EpiCenter for Sexual Health and Medicine, St. Paul, Minnesota, USA

Manuscript received May 5, 2003; revised manuscript received July 2, 2003, accepted July 14, 2003.

^* Reprint requests and correspondence: Dr. Alan J. Bank, Associate Professor, University of Minnesota, Director of Research, St. Paul Heart Clinic, 255 N. Smith Avenue, Suite 100, St. Paul, Minnesota 55102, USA.
abank{at}stphc.com

OBJECTIVES: 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.

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Abbreviations and Acronyms   CAD = coronary artery disease   ED = erectile dysfunction   EDV = end-diastolic velocity   FMD = flow-mediated vasodilation   HDL = high-density lipoprotein   IIEF-15 = 15-item International Index of Erectile Function   IMT = intima-media thickness   LDL = low-density lipoprotein   NL = normal control subjects   NO-cGMP = nitric oxide–cyclic guanosine-3'5'-monophosphate   NTG = nitroglycerin   PGE1 = prostaglandin E1   PSV = peak systolic velocity   PWV = pulse wave velocity   RI = resistance index

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