Erectile dysfunction (ED) is an early manifestation of a generalized arterial disease. The association between penile vascular disease progression and total atherosclerotic burden was investigated using a classification that incorporates ultrasonographic assessments of intima media thickness (IMT) and plaques from both the carotid and femoral arteries.
Methods:
Sixty-five ED patients (mean age, 56±10 yrs) were evaluated for cavernous vascular disease severity using penile Doppler ultrasound. Ultrasonographic assessments of IMT, lumen diameter, and plaques in the carotid and femoral arteries were evaluated, and patients were classified according to an ultrasound-based morphological system.
Results:
Based on the results of ultrasonic assessments, patients were divided into two groups—a high-score group and a low-score group. Patients in the high-score group had increased intima-media (>1.0 mm) and/or plaque in any of the four arteries. Patients in the low-score group had normal carotid and femoral IMT and an absence of plaques in all four arteries. While the two groups did not differ in blood pressure parameters, metabolic profile, and smoking status, high-score patients (n=31) had significantly decreased age-adjusted peak systolic velocity (25.2 cm versus 32.3 cm/s, P<0.01) and a longer duration of ED (3.8 years versus 2 years, P<0.05), compared with low-score patients (n=34). In the high-score group, score level was inversely correlated with peak systolic velocity after adjusting for age and systolic blood pressure (b=−0.322, P=0.025). There also was a positive linear relation of ED duration with prevalence of high score (P<0.05).
Conclusions:
In patients with vasculogenic ED, ultrasound findings of penile vasculature damage and long-standing ED correlate significantly with increasing carotid and femoral atherosclerotic burden. These data suggest a close interrelationship between progression of vasculogenic ED and peripheral atherosclerosis.
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References
1.
VardiY, DayanL, AppleB, GruenwaldI, OferY, JacobG. Penile and systemic endothelial function in men with and without erectile dysfunction. Eur Urol, 2009; 55:979–985.
MontorsiP, RavagnaniPM, GalliS, et al.Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: The COBRA trial. Eur Heart J, 2006; 22:2632–2639.
4.
MontorsiP, RavagnaniPM, GalliS, et al.Association between erectile dysfunction and coronary artery disease: Matching the right target with the right test in the right patient. Eur Urol, 2006; 50:721–731.
5.
ChiurliaE, D'AmicoR, RattiC, GranataA, RomagnoliR, ModenaM. Subclinical coronary artery atherosclerosis in patients with erectile dysfunction. J Am Coll Cardiol, 2005; 46:1503–1506.
6.
VlachopoulosC, RokkasK, IoakeimidisN, et al.Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: A prospective angiographic study. Eur Urol, 2005; 48:996–1002.
7.
VlachopoulosCV, Terentes-PrintziosDG, IoakeimidisNK, AznaouridisKA, StefanadisCI. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: A systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes, 2013; 6:99–109.
8.
GriffinM, NicolaidesA, TyllisT, et al.Carotid and femoral arterial wall changes and the prevalence of clinical cardiovascular disease. Vasc Med, 2009; 14:227–232.
9.
LorenzMW, PolakJF, KavousiM, et al.Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): A meta-analysis of individual participant data. Lancet, 2012; 379:2053–2062.
10.
LorenzMW, MarkusHS, BotsML, RosvallM, SitzerM. Prediction of clinical cardiovascular events with carotid intima-media thickness: A systematic review and meta-analysis. Circulation, 2007; 115:459–467.
11.
CostanzoP, Perrone-FilardiP, VassalloE, et al.Does carotid intima-media thickness regression predict reduction of cardiovascular events? A meta-analysis of 41 randomized trials. J Am Coll Cardiol, 2010; 56:2006–2020.
12.
KirhmajerMV, BanficL, VojkovicM, StrozziM, BulumJ, MiovskiZ. Correlation of femoral intima-media thickness and the severity of coronary artery disease. Angiology, 2011; 62:134–139.
13.
SosnowskiC, PasierskiT, Janeczko-SosnowskaE, et al.Femoral rather than carotid artery ultrasound imaging predicts extent and severity of coronary artery disease. [In Polish.] Kardiol Pol, 2007; 65:760–766.
14.
BelcaroG, NicolaidesA, NicolaidesA, LauroraG, et al.Ultrasound morphology classification of the arterial wall and cardiovascular events in a 6-year follow up study. Arterioscler Thromb Vasc Biol, 1996; 16:851–856.
15.
de BrayJM, BaudJM, DauzatM. Consensus concerning the morphology and the risk of carotid plaques. Cerebrovasc Dis, 1997; 7:289–296.
16.
LekakisJP, PapamichaelC, PapaioannouTG, et al.Intima-media thickness score from carotid and femoral arteries predicts the extent of coronary artery disease: Intima-media thickness and CAD. Int J Cardiovasc Imaging, 2005; 21:495–501.
17.
CoronaG, MonamiM, BoddiV, et al.Male sexuality and cardiovascular risk. A cohort study in patients with erectile dysfunction. J Sex Med, 2010; 7:1918–1927.
18.
VicariE, Di PinoL, La VigneraS, et al.Peak systolic velocity in patients with arterial erectile dysfunction and peripheral arterial disease. Int J Impot Res, 2006; 18:175–179.
19.
El-SakkaAI, MorsyAM. Screening for ischemic heart disease in patients with erectile dysfunction: Role of penile Doppler ultrasonography. Urology, 2004; 64:346–350.
20.
CarettaN, PalegoP, RoveratoA, SeliceR, FerlinA, ForestaC. Age-matched cavernous peak systolic velocity: A highly sensitive parameter in the diagnosis of arteriogenic erectile dysfunction. Int J Impot Res, 2006; 18:306–310.
21.
GoksuC, DeveerM, SivriogluAK, et al.Peripheral atherosclerosis in patients with arterial erectile dysfunction. Int J Impot Res, 2014; 26:55–60.
22.
BocchioM, ScarpelliP, NecozioneS, et al.Penile duplex pharmaco-ultrasonography of cavernous arteries in men with erectile dysfunction and generalized atherosclerosis. Int J Androl, 2006; 29:496–501.
23.
D'AgostinoRBSr, VasanRS, PencinaMJ, et al.General cardiovascular risk profile for use in primary care: The Framingham Heart Study. Circulation, 2008; 117:743–753.
24.
CappelleriJC, RosenRC. The Sexual Health Inventory for Men (SHIM): A 5-year review of research and clinical experience. Int J Impot Res, 2005; 17:307–319.
25.
AversaA, SarteschiLM. The role of penile color-duplex ultrasound for the evaluation of erectile dysfunction. J Sex Med, 2007; 4:1437–1447.
26.
BelcaroG, FisherCM, VellerMG, et al.Screening asymptomatic subjects with subclinical arteriosclerotic lesions with arterial ultrasonic biopsy: The PAP study. Vasa, 1993; 22:232–240.
27.
VlachopoulosC, JacksonG, StefanadisC, MontorsiP. Erectile dysfunction in the cardiovascular patient. Eur Heart J, 2013; 34:2034–2046.
28.
NehraA, JacksonG, MinerM, et al.Diagnosis and treatment of erectile dysfunction for reduction of cardiovascular risk. J Urol, 2013; 189:2031–2038.
29.
BlumentalsWA, Gomez-CamineroA, JooS, VannappagariV. Should erectile dysfunction be considered as a marker for acute myocardial infarction? Results from a retrospective cohort study. Int J Impot Res, 2004; 16:350–353.
30.
VlachopoulosC, IoakeimidisN, RokkasK, StefanadisC. Cardiovascular effects of phosphodiesterase type 5 inhibitors. J Sex Med, 2009; 6:658–674.
31.
NehraA. Erectile dysfunction and cardiovascular disease: Efficacy and safety of phosphodiesterase type 5 inhibitors in men with both conditions. Mayo Clin Proc, 2009; 84:139–148.
32.
GazzarusoC, SolerteSB, PujiaA, et al.Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with angiographically proven asymptomatic coronary artery disease: A potential protective role for statins and 5-phosphodiesterase inhibitors. J Am Coll Cardiol, 2008; 51:2040–2044.
33.
SaadF, HaiderA, DorosG, TraishA. Long-term treatment of hypogonadal men with testosterone produces substantial and sustained weight loss. Obesity (Silver Spring), 2013; 21:1975–1981.
34.
NehraA, JacksonG, MinerM, et al.The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc, 2012; 87:766–778.
35.
LekakisJP, PapamichaelCM, CimponeriuAT, et al.Atherosclerotic changes of extracoronary arteries are associated with the extent of coronary atherosclerosis. Am J Cardiol, 2000; 85:949–952.
36.
VlachopoulosC, AznaouridisK, IoakeimidisN, et al.Unfavourable endothelial and inflammatory state in erectile dysfunction patients with or without coronary artery disease. Eur Heart J, 2006; 27:2640–2648.
37.
VlachopoulosC, IoakeimidisN, Terentes-PrintziosD, et al.Amino-terminal pro-C-type natriuretic peptide is associated with the presence, severity, and duration of vasculogenic erectile dysfunction. Eur Urol, 2009; 56:552–558.
38.
IoakeimidisN, VlachopoulosC, RokkasK, et al.Relationship of asymmetric dimethylarginine with penile Doppler ultrasound parameters in men with vasculogenic erectile dysfunction. Eur Urol, 2011; 59:948–955.
39.
MironeV, ImbimboC, FuscoF, VerzeP, CretaM, TajanaG. Androgens and morphologic remodeling at penile and cardiovascular levels: A common piece in complicated puzzles?. Eur Urol, 2009; 56:309–316.
40.
MullerM, van den BeldAW, BotsML, GrobbeeDE, LambertsSW, van der SchouwYT. Endogenous sex hormones and progression of carotid atherosclerosis in elderly men. Circulation, 2004; 109:2074–2079.
41.
VlachopoulosC, AznaouridisK, IoakeimidisN, et al.Arterial function and intima-media thickness in hypertensive patients with erectile dysfunction. J Hypertens, 2008; 26:1829–1836.
42.
VlachopoulosC, IoakeimidisN, MinerM, et al.Testosterone deficiency: A determinant of aortic stiffness in men. Atherosclerosis, 2014; 233:278–283.
43.
BankAJ, KellyAS, KaiserDR, et al.The effects of quinapril and atorvastatin on the responsiveness to sildenafil in men with erectile dysfunction. Vasc Med, 2006; 11:251–257.
44.
CarettaN, PalegoP, SchipillitiM, FerlinA, Di MambroA, ForestaC. Cavernous artery intima-media thickness: A new parameter in the diagnosis of vascular erectile dysfunction. J Sex Med, 2009; 6:1117–1126.
