Erectile dysfunction and cardiovascular disease

How are erectile dysfunction and cardiovascular disease connected?

Dr. Steven Lamm lecture at AUA 09

In recent years investigators have observed that the onset of erectile dysfunction is often followed a few years later by the onset of cardiovascular events¹. The evidence is pointing towards endothelial function as the clinical connection between these two afflictions. This is hardly surprising, as endothelial dysfunction is a systemic disease, afflicting multiple target organs. Endothelial dysfunction is increasingly recognized as the root cause of atherosclerotic plaque formation. Its clinical manifestations are coronary artery disease, erectile dysfunction, stroke and other cardiovascular diseases.

The clinical implications of endothelial dysfunction are so grave that in 2003 investigators from the Mayo Clinic stated that “endothelial dysfunction may be regarded as the ultimate risk of the risk factors” ².

The impact of these new findings on patient management is immense: from viewing erectile dysfunction as a harbinger of future cardiovascular events³, to prevention of erectile dysfunction itself.

Erectile dysfunction and cardiovascular disease – size matters!

The degenerative remodeling of the vascular walls is a silently progressive process called subclinical atherosclerosis. It develops over years, even decades. Usually, smaller vessels, such as in the penile vasculature, become occluded more quickly than larger vascular beds, such as the coronaries. This means that, generally, erectile dysfunction will have an earlier clinical presentation than in the larger coronaries.

Lately urologists are beginning to equate endothelial dysfunction with erectile dysfunction⁴. In 2006 the European Urology Association pointed to office-based endothelial function tests as useful in stratifying cardiovascular disease risk in patients who present with erectile dysfunction.

The obvious goal is to detect cardiovascular disease progression while it is still in its subclinical stages. As endothelial dysfunction is the earliest clinically detectable stage of cardiovascular diseases, it is a prime candidate for this purpose. What makes endothelial dysfunction even more appealing is that it is treatable, and unlike the plaque, even reversible.

This means that monitoring endothelial function provides clinicians with both better management of erectile dysfunction, as well as better control of cardiovascular disease risk.

References:

• 1. IM Thompson et al.; “Erectile Dysfunction and Subsequent Cardiovascular Disease” JAMA2005; 294:2996-3002
• 2. PO Bonetti et al.: “Endothelial Dysfunction A Marker of Atherosclerotic Risk” Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23:168
• 3. RA. Kloner; “Erectile Dysfunction: The New Harbinger for Major Adverse Cardiac Events in the Diabetic Patient” J Am Coll Cardiol 2008 51: 2051-2052
• 4. A Muller, JP Mulhall; “Cardiovascular disease, metabolic syndrome and erectile dysfunction” Current Opinion in Urology; November 2006;16(6):435-443

Further reading:

The connection between erectile dysfunction and endothelial dysfunction:

• Tamler R, Bar-Chama N. “Assessment of endothelial function in the patient with erectile dysfunction: an opportunity for the urologist” International Journal of Impotence Research,2008 ,1-8
• H Solomon et al.; “Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator.” Heart 2003; 89; 251-253

The connection between endothelial dysfunction and cardiovascular disease:

• Celermajer, David S. “Reliable Endothelial Function Testing: At Our Fingertips?” Circulation 2008; 117(19): 2428-2430
• JE Deanfield et al.; “Endothelial Function and Dysfunction: Testing and Clinical Relevance” Circulation 2007; 115;1285-1295

The timeline of progression between erectile dysfunction and cardiovascular disease:

• IM Thompson et al.; “Erectile Dysfunction and Subsequent Cardiovascular Disease” JAMA2005; 294:2996-3002