Penile hemodynamics predict cardiovascular disease

Berlin-It's well established that erectile dysfunction is associated with traditional coronary artery disease risk factors, including diabetes, hypertension, and high cholesterol. Now research has shown that penile hemodynamic findings are related to vascular risk factors. In addition, hypertension, followed by hypercholesterolemia and beta-antagonist therapy, are strong predictors of severe arteriogenic erectile dysfunction, as shown by multiple logistic regression analysis, Greek researchers reported at the European Association of Urology annual congress here.

Konstantinos Rokkas, MD, and his team of researchers in the cardiovascular diseases and sexual health unit at the Hippokration Hospital, Athens Medical School, conducted a study to investigate and clarify the effect of individual cardiovascular disease risk factors on penile vascular hemodynamics.

In the study, 123 men (mean age, approximately 60 years) with symptoms of erectile dysfunction were evaluated by Doppler ultrasound for penile vascular disease severity. Forty-four of the men were receiving treatment for hypertension, 26 had hypercholesterolemia, and 25 had diabetes. Another 28 men with no risk factors served as the control group, and were matched with the first group for age, body mass index, and intensity of smoking.

"In our results, we saw that the greatest difference in the peak systolic velocity was found in the hypertensive patients, and the greatest increase in the end diastolic velocity was seen in the diabetic patients," Dr. Rokkas said. "Furthermore, men with no risk factors showed similar values of end diastolic velocity to those of diabetic men, and higher values compared to the patients with hypertension and hypercholesterolemia.

"In my opinion, these findings clearly demonstrate the close interrelationship between vascular risk factors and erectile dysfunction."

Vascular rigidity as marker

Corollary to these findings, erectile dysfunction may be a sign of general vascular disease, and intima media thickness and aortic stiffness are markers and prognostic factors for cardiovascular risk.

Dr. Rokkas and his colleagues conducted a parallel study that included 95 men (mean age, 62±9 years) with erectile dysfunction. Of these, 36 men had coronary artery disease and 59 did not.

Researchers assessed vascular damage in all participants by measuring the mean intima media thickness of the common carotid arteries, the carotid-femoral pulse wave velocity as an index of aortic stiffness, and pharmacologically stimulated peak systolic velocity of cavernous arteries as an indicator of vascular damage.

"After adjusting for potential confounding factors, such as age, mean pulse pressure, body mass index, total cholesterol, high density lipoproteins, and intensity of smoking, we found that carotid intima media thickness and aortic stiffness were definitively associated with impaired erectile function in our patients," Dr. Rokkas said.

Results showed that patients with coronary artery disease demonstrated decreased peak systolic velocity (27.2 vs. 33.8 cm/second, p=.01), increased intima media thickness (0.98 vs. 0.82 mm, p<.001), and increased carotid-femoral pulse wave velocity (8.9 vs. 8.2 meters/second, p<.01) compared to patients without coronary artery disease.

"This data is important as it provides further insights into the pathophysiology of erectile dysfunction and may have implications for the cardiovascular risk in these patients," Dr. Rokkas affirmed.

Ignacio Moncada-Iribarren, MD, a member of the urologic service at Hospital General Universitario Gregorio Marañón Madrid, Spain, pointed out that most urologists are aware that vascular risk factors are associated with penile Doppler findings.

"Having said that, what is your take-home message?" he asked.

"Our results highlighted the relation between hypertension, hypercholesterolemia, and the use of beta-blockers in arteriogenic erectile dysfunction," Dr. Rokkas responded. "Patients with those characteristics have a greater probability to present with arterial insufficiency, which has a direct effect on erectile dysfunction. These data suggest that patients with erectile dysfunction should be advised to undergo vascular tests."