Impaired brachial artery endothelium-dependent and -independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease
Key result
Erectile dysfunction is linked to ~1-point lower brachial flow-mediated vasodilation compared with controls.
- P=0.014
- n=57
Why the study?
Vascular disease is a major cause of erectile dysfunction (ED), raising the possibility that ED is an early marker of atherosclerosis. Whether patients with vascular ED and no other clinical cardiovascular disease have structural and functional abnormalities in other vascular beds was undetermined.
Do men with vascular erectile dysfunction and no other clinical cardiovascular disease have impaired brachial artery endothelium-dependent and -independent vasodilation or other structural and functional vascular abnormalities compared to age-matched normal controls?
Study Design
Type
Case-Control (n=57)
Structured PICO
Do men with vascular erectile dysfunction and no other clinical cardiovascular disease have impaired brachial artery endothelium-dependent and -independent vasodilation or other structural and functional vascular abnormalities compared to age-matched normal controls?
P
Population
57 men (30 with vascular erectile dysfunction and no clinical cardiovascular disease, and 27 age-matched normal controls) assessed for systemic vascular structure and function.
E
Exposure
Assessment of systemic vascular structure and function, including nitroglycerin administration to assess endothelium-independent vasodilation.
C
Comparator
Age-matched normal control (NL) subjects without erectile dysfunction (n=27).
O
Outcome
Brachial artery endothelium-dependent (flow-mediated vasodilation [FMD]) and endothelium-independent (vasodilation to nitroglycerin [NTG]) vasodilation.surrogate
Main Result
Absolute Event Rate: 1.3% vs 2.4%
p-value: p=0.014
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“These data suggest that young men with ED but no clinical evidence of cardiovascular disease or other risk factors for it have generalized impairment of both endothelium-dependent and -independent vasodilation. The authors speculate that an abnormality in the peripheral vascular NO-cyclic guanosine-3'5'-monophosphate vasodilation pathway can make ED the first clinical manifestation of cardiovascular disease, potentially independent of traditional risk factors.”
Implication
Men with erectile dysfunction and no overt clinical cardiovascular disease exhibit impaired peripheral endothelium-dependent and -independent vasodilation prior to the development of other structural or functional systemic vascular abnormalities.
Abstract
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. Method 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.
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
Kaiser et al. (2004) conducted a case-control in Vascular erectile dysfunction without clinical cardiovascular disease (n=57). Vascular erectile dysfunction vs. Age-matched normal control subjects was evaluated on Brachial artery flow-mediated vasodilation (FMD) (p=0.014). Men with erectile dysfunction had reduced brachial flow-mediated (1.3% vs 2.4%, p=0.014) and nitroglycerin-induced (13.0% vs 17.8%, p<0.05) vasodilation vs controls.