Brachial artery flow-mediated dilatation and carotid intima-media thickness in young ED patients with insulin resistance

Abstract

The evidence of a close relationship between cardiovascular disease and erectile dysfunction (ED) is well documented. The aim of this study is to investigate whether there is an early asymptomatic impairment of the peripheral vasculature in young ED patients without obvious cardiovascular disease. We studied a total of 261 ED patients (19-40 years old) and 40 age-matched healthy controls. All participants received questionnaires of cardiovascular risk factors and erectile function assessment, were subjected to lab tests of fasting blood sample, and underwent the ultrasonographic examination of brachial artery flow-mediated dilation (FMD) and carotid intima-media thickness (c-IMT). Insulin resistance (IR) was measured by the homeostasis model assessment of insulin resistance (HOMA-IR). Compared with normal human controls, FMD was significantly lower, whereas the average c-IMT was significantly greater in ED patients. An inverse correlation was found between FMD and mean c-IMT. The ED patients had significantly higher levels of fasting glucose, fasting insulin and HOMA-IR index, but showed relatively lower total testosterone and prolactin levels than the controls. Both FMD and c-IMT showed a significant correlation with International Index of Erectile Function-5 questionnaire (IIEF-5) score, age and HOMA-IR. Multivariate stepwise regression analysis demonstrated that age, HOMA-IR and IIEF-5 score were the risk factors associated with FMD and c-IMT. In conclusion, young ED patients in association with IR display diminished FMD and increased c-IMT. Furthermore, ED, HOMA-IR and age are independent predictors of the two subclinical atherosclerotic markers.

The relationship of erectile dysfunction and subclinical cardiovascular disease: A systematic review and meta-analysis

“…In all, 15 studies examined endothelial dysfunction as an outcome, with all these measuring FMD and none measuring RHI. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Twelve studies examined cIMT outcomes, 28,34,35,38,40,[42][43][44][45][46][47][48] five studies measured CAC 28,29,37,49,50 and six studies had various measures of vascular stiffness and peripheral vascular disease such as PWV, Augmentation Index (AIx), ABI, and TBI. 28,[51][52][53][54][55] All the studies with FMD (n=15) and cIMT (n=12) outcomes were included in the meta-analysis regardless of their quality.…”

“…A total of 15 studies with 2025 participants examined the relationship between ED and FMD. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] They all measured brachial FMD; however, the methods of FMD assessment were not universal among the studies. Seven of the 15 studies had the cuff placed on the forearm (including one which described the wrist), [28][29][30][31][32]37,39 while the others either had the cuff inflated over the arm 36,38,40,42 or did not specify.…”

“…[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] They all measured brachial FMD; however, the methods of FMD assessment were not universal among the studies. Seven of the 15 studies had the cuff placed on the forearm (including one which described the wrist), [28][29][30][31][32]37,39 while the others either had the cuff inflated over the arm 36,38,40,42 or did not specify. [33][34][35]41 In addition, the inflating pressures were inconsistent as studies reported pressures between 250 mmHg and 300 mmHg, 28,[30][31][32]38,40,42 while others had cuff pressures 50 mmHg above the systolic BP.…”

“…Seven of the 15 studies had the cuff placed on the forearm (including one which described the wrist), [28][29][30][31][32]37,39 while the others either had the cuff inflated over the arm 36,38,40,42 or did not specify. [33][34][35]41 In addition, the inflating pressures were inconsistent as studies reported pressures between 250 mmHg and 300 mmHg, 28,[30][31][32]38,40,42 while others had cuff pressures 50 mmHg above the systolic BP. 29,[33][34][35][36]39 One study had cuff pressures at least 100 mmHg above the systolic BP.…”

“…Twelve studies with 1264 participants assessed the relationship between ED and cIMT. 28,34,35,38,40,[42][43][44][45][46][47][48] Eight of these studies assessed IMT in the common carotid arteries, 28,34,35,[42][43][44]46,48 one study measured IMT at the common carotid, carotid bifurcation and the proximal internal carotid artery on each side, 43 while no location was specified in three studies. 38,40,45,47 The methods of assessing ED were also the IIEF-15 (seven studies) and the IIEF-5 (five studies).…”