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.
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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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