EditorialIs Erectile Dysfunction the “Tip of the Iceberg” of a Systemic Vascular Disorder?
Section snippets
ED as the “tip of the iceberg”
Atherosclerosis is a systemic disorder that uniformly affects all major vascular beds. Nevertheless, clinical manifestations of vascular diseases rarely appear simultaneously in the same patient. This may occur because arteries supplying various districts (i.e. penis, heart, brain, lower limbs) do have different size. Fig. 1 depicts the hypothetical vascular situation of a patient with isolated ED. A >50% lumen obstruction (i.e. the cut-off to define a flow-limiting stenosis) of the penile
Exceptions to the rule
A wide range of ED prevalence in patients with various vascular diseases has been reported in the literature. Reasons are difference in population characteristics, definition of ED, sensitivity and specificity of tests used to diagnose CAD, CVD or PAD, and side-effects of concomitant pharmacological treatment. Moreover, CAD’s clinical characteristics may explain the finding of patients with previous myocardial infarction having normal sexual tests. Indeed, AMI is the initial manifestation of
Clinical implications
From a practical point of view, clinical significance of ED is different depending on from which side it is viewed. While the detection of ED in a patient with known CAD mainly rises the issue of safety of treatment with oral phoshodiesterase type 5 inhibitors, the detection of isolated ED rises a more important question about concomitant, latent, vascular diseases. Coronary artery disease is by far the most important problem that needs to be investigated. Negative tests are likely to be found
References (26)
- et al.
Impotence and its medical and psychological correlates: results of the Massachusset Male Aging Study
J. Urol.
(1994) - et al.
Is impotence an arterial disease? A study of arterial risk factors in 440 impotence men
Lancet
(1985) - et al.
Potential predictors of asymptomatic ischemic heart disease in patients with vasculogenic erectile dysfunction
Urology
(2001) - et al.
Diagnostic steps in the evaluation of patients with erectile dysfunction
J. Urol.
(2002) - et al.
Relation of erectile dysfunction to angiographic artery disease
Am. J. Cardiol.
(2003) - et al.
Relationship of penile brachial pressure index to myocardial infarction and cerebrovascular accidents in older men
Am. J. Med.
(1988) Erectile dysfunction
New Engl. J. Med.
(2000)- et al.
The epidemiology of erectile dysfunction and its risk factors
Int. J. Androl.
(1997) - et al.
Myocardial infarction and its influence on male sexual function
Arch. Sexual Behavior
(1986) - et al.
Sexual dysfunction in stoke patients
Acta Neurol. Scand.
(1998)
Erectile and endothelial dysfunction in type II diabetes: a possibile link
Diabetologia
Morphologic changes in the arterial bed of the penis with aging. Relationship to the pathogenesis of impotence
Invest. Urol.
Erectile dysfunction: is there silent obstructive coronary artery disease?
Int. J. Clin. Pract.
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