Erectile dysfunction (ED) is a common disorder whose prevalence increases with age. Over time a strong correlation between erectile dysfunction and cardiovascular disease has been established as the result of the same pathophysiological process: endothelial dysfunction and atherosclerosis. Because small vessels of the penis can be affected by atherosclerotic plaque earlier than coronary arteries, carotids or femoral arteries, men often have symptoms of ED long before the signs of cardiovascular disease appear. For this reason, ED can act as a marker of early atherosclerosis that predicts the onset of cardiovascular disease at a later time. Erectile dysfunction (ED) is de ined as the inability to achieve and/or sustain an adequate erection to complete a sexual relationship; it may be accompanied by decreased libido and abnormal ejaculation [1]. It is a common disorder and its prevalence increases with age, being more frequent in elderly men. It affects 5-10% of those over 40's and 40-70% of those over 70's; it is estimated that there are about 150 million affected men worldwide and that by 2025 it will affect more than 300 million [2-5].
ShortOver time many studies have shown a correlation between ED and cardiovascular risk; both entities share many risk factors such as age, type 2 diabetes mellitus (DM2), hypertension (HT), dyslipidemia, smoking, obesity and sedentary lifestyle [6][7][8][9]. Therefore, it is believed that ED and coronary artery disease (CAD) are clinical manifestations of the same pathophysiological process, product of a severe endothelial dysfunction [10][11][12]. In the study conducted by Demirkol S et al., it was found that erectile function was signi icantly decreased in patients who presented both microvascular angina (syndrome X) and CAD, thus they conclude that ED and syndrome X are manifestations of a common vascular phenomenon that includes endothelial dysfunction as the mechanism underlying both conditions [4].The pathophysiology of microvascular angina has not been clearly elucidated, although several abnormalities have been proposed including: alteration in coronary low reserve, insulin resistance, abnormal autonomic control and microvascular spasm; all these, also associated with endothelial dysfunction, which is another traditional risk factor for cardiovascular disease and occurs before the development of apparent functional or structural systemic vascular disease [6,12]. It is characterized by a decrease in the bioavailability of endogenous nitric oxide (NO) and increase in plasma levels of endothelin-1, promoting in turn an increase in oxidative stress and vasoconstrictor mediators such as angiotensin II, causing generalized damage in the vascular endothelium, being the arteries of the penis more susceptible due to their size and therefore affected earlier 4 . In this way, both the loss in bioavailability of NO and endothelial dysfunction are phenomena that occur in the earliest stages of atherosclerosis and are also associated with traditional risk factors of cardiovasc...