“We think that erectile dysfunction represents the ‘tip of the iceberg’ of a systemic vascular disorder; thus potentially preceding severe cardiovascular events and should be part of any cardiovascular risk assessment.”
These patients should be considered at high risk for coronary artery disease and should have high priority for aggressive treatment," said Emilio Chiurlia, Ph.D. from the University of Modena and Reggio Emilia in Modena, Italy.
The researchers studied 70 men with erectile dysfunction and 73 control subjects who were of similar age and race (all Caucasian), and had similar coronary risk factor scores according to estimates published by the National Cholesterol Education Panel III. None of the men had symptoms of coronary atherosclerosis.
The men with erectile dysfunction had higher levels of C-reactive protein (an emerging coronary risk factor), they were more likely to have abnormal blood vessel responses to changes in blood flow (as measured by flow mediated dilation), and more of them had coronary artery calcifications detected on coronary CT scans.
"When a man is diagnosed with erectile dysfunction, clinicians should be aware that erectile dysfunction would represent an early clinical manifestation of a diffuse subclinical vascular disease and coronary artery disease is the most important problem that needs to be investigated. The smaller penile arteries suffer obstruction from plaque burden earlier than the larger coronary arteries hence erectile dysfunction may be symptomatic before a coronary event," Dr. Chiurlia said.
Dr. Chiurlia noted that this study involved only a small number of men and did not follow them over time to see which ones actually developed heart disease.
"We need prospective studies addressing the precise role of erectile dysfunction as a marker of cardiovascular disease," he said.
While awaiting the results of such future studies, he said erectile dysfunction should raise suspicions about early atherosclerosis, even in men who would not otherwise be considered at high risk.
"In our opinion, erectile dysfunction should be considered, like diabetes, a ‘cardiovascular equivalent,’" Dr. Chiurlia said.
Renke Maas, M.D., from the University-Hospital Hamburg-Eppendorf in Hamburg, Germany, who was not connected with this research, agreed with the main conclusion of the study.
"The present study by Chiurlia et al. lends strong support to the notion that erectile dysfunction may be an early warning sign of clinically-silent coronary artery disease. Despite limitations set by sample size and the cross-sectional study design with a long list of exclusion criteria, it is a strength of the present work that it assesses major aspects connecting erectile dysfunction and more generalized vascular disease in one study," Dr. Maas said.
Paul Schoenhagen, M.D., from the Cleveland Clinic Foundation in Cleveland, Ohio, who also was not connected with the research, said it provides evidence of related problems in two different regions of the arterial tree.
"These results demonstrate the systemic nature of atherosclerosis and the relationship to an inflammatory process of the vessel wall. This understanding of atherosclerosis increasingly allows early interventions aimed at the prevention of disease complications," Dr. Schoenhagen said.
Journal of the American College of Cardiology Oct. 18, 2005
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