Does severity of ischaemic coronary disease correlate with erectile function?

Abstract

Greenstein et al 1 report a signi®cant correlation between the number of coronary vessels occluded on angiography and erectile dysfunction (ED). This is an important ®nding because previous links between ischaemic heart disease (IHD) and ED have been largely restricted to demonstrating that these conditions share common risk factors (for example, smoking, dyslipidaemia, diabetes and hypertension). 2 ± 4 In addition, some of the drugs (for example anti-hypertensives) used to treat IHD can cause ED. If the pathogenesis of IHD and ED is similar, then other predictors of vascular events should be shared by both these conditions. We therefore assessed plasma ®brinogen concentrations in men with ED and in matched controls. Our results reveal higher levels of this coagulation factor in those with ED. 4 We are currently evaluating lipoprotein (a) levels in men with ED. This lipoprotein is another predictor of a variety of vascular events (for example, myocardial infarction and stroke). These studies would support the routine screening of patients with vasculogenic ED for cardiovascular risk factors.Good diabetic and blood pressure control are well recognised therapies, but current evidence also raises the question of early intervention with lipidlowering agents (some of which are known to reduce ®brinogen levels). Support for such an approach comes from several studies, 5,6 which showed a signi®cant reduction in cardiovascular events and a reduction in the progression of coronary atheromatous lesions in patients with hypercholesterolaemia taking lipid-lowering therapy (for example 4S 5 and MAAS 6 ).Finally, medical practitioners who treat patients with ED should be aware of potential underlying IHD and its clinical relevance in terms of`whole patient management.' References

Prevalence of erectile dysfunction and its correlates among men attending primary care clinics in three countries: Pakistan, Egypt, and Nigeria

“…ED is primarily a vascular condition, [15][16][17][18][19][20][21] an etiology supported by our finding of a higher prevalence of ED in men with diabetes, hypertension, and (marginally) with heart disease in ageadjusted bivariate analyses. In the multivariate model, however, only diabetes was independently associated with ED, which was also the case in the Cross-National Study.…”

Association between metabolic syndrome and sexual dysfunction among men with clinically diagnosed diabetes

“…The role of lipid profile including TC, LDL-c and TG cannot be ignored due to their positive correlation with non-communication, avoidance and infrequency which are key determinants of sexual functioning in an individual. In MetS subjects, increased production of cholesterol, LDL-c and TG can lead to destruction of endogenous nitric oxide synthetase [36,37], decreased bioavailability of NO, increase in vasoconstrictor factors and hence damaged endothelium-based vasodilatation at the early stages of atherosclerosis [38,39]. Further scientific enquiry is required for the establishment of a reciprocal cause between MetS and SD among diabetic male patients.…”

Dyslipidemia as a Risk Factor for Erectile Dysfunction

“…Men with ED who smoked had a significantly higher plasma fibrinogen level than control smokers. Similarly, men with ED, who did not smoke had higher levels of plasma fibrinogen compared to both smokers and nonsmokers without ED [51]. Additionally, ED was significantly associated with increased levels of inflammatory [highsensitivity-CRP (hs-CRP), Interleukin-1beta (IL-1beta), and TNF-alpha)]…”