Erectile Dysfunction May Signal Early Atherosclerosis

"We think that erectile dysfunction represents the 'tip of theiceberg' of a systemic vascular disorder; thus potentially precedingsevere cardiovascular events. Erectile dysfunction should be part of acardiovascular risk assessment. These patients should be considered athigh risk for coronary artery disease and should have high priority foraggressive treatment," said Emilio Chiurlia, Ph.D. from the Universityof Modena and Reggio Emilia in Modena, Italy.

The researchers studied 70 men with erectile dysfunction and 73control subjects who were of similar age and race (all Caucasian), andhad similar coronary risk factor scores according to estimatespublished by the National Cholesterol Education Panel III. None of themen had symptoms of coronary atherosclerosis.

The men with erectile dysfunction had higher levels ofC-reactive protein (an emerging coronary risk factor), they were morelikely to have abnormal blood vessel responses to changes in blood flow(as measured by flow mediated dilation), and more of them had coronaryartery calcifications detected on coronary CT scans.

"When a man is diagnosed with erectile dysfunction, cliniciansshould be aware that erectile dysfunction would represent an earlyclinical manifestation of a diffuse subclinical vascular disease andcoronary artery disease is the most important problem that needs to beinvestigated. The smaller penile arteries suffer obstruction fromplaque burden earlier than the larger coronary arteries hence erectiledysfunction may be symptomatic before a coronary event," Dr. Chiurliasaid.

Dr. Chiurlia noted that this study involved only a small numberof men and did not follow them over time to see which ones actuallydeveloped heart disease.

"We need prospective studies addressing the precise role oferectile dysfunction as a marker of cardiovascular disease," he said.

While awaiting the results of such future studies, he saiderectile dysfunction should raise suspicions about earlyatherosclerosis, even in men who would not otherwise be considered athigh 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-Eppendorfin Hamburg, Germany, who was not connected with this research, agreedwith the main conclusion of the study.

"The present study by Chiurlia et al. lends strong support tothe notion that erectile dysfunction may be an early warning sign ofclinically-silent coronary artery disease. Despite limitations set bysample size and the cross-sectional study design with a long list ofexclusion criteria, it is a strength of the present work that itassesses major aspects connecting erectile dysfunction and moregeneralized vascular disease in one study," Dr. Maas said.

Paul Schoenhagen, M.D., from the Cleveland Clinic Foundation inCleveland, Ohio, who also was not connected with the research, said itprovides evidence of related problems in two different regions of thearterial tree.

"These results demonstrate the systemic nature ofatherosclerosis and the relationship to an inflammatory process of thevessel wall. This understanding of atherosclerosis increasingly allowsearly interventions aimed at the prevention of disease complications,"Dr. Schoenhagen said.