Relation of C-reactive protein and other cardiovascular risk factors to penile vascular disease in men with erectile dysfunction

Abstract

Erectile dysfunction (ED) may be an early sign or symptom of cardiovascular disease (CVD). We examined the relation of traditional and emerging risk factors for CVD to the severity of penile vascular disease in men with ED and without clinical coronary artery disease (CAD). In total, 137 men with ED were evaluated for penile vascular disease severity by penile Doppler ultrasound. These men were divided into the following groups based on ultrasound results: normal, cavernous venous occlusive disease, mild arterial insufficiency, and severe arterial insufficiency. Traditional (fasting lipid panel, fasting glucose, age, BMI, smoking, Framingham coronary artery disease risk score) and emerging (C-reactive protein, Lp(a), homocysteine) risk factors for CVD were correlated to severity of penile vascular disease in men with ED and without clinical CAD. Using univariate analysis, penile Doppler groups showed significant positive correlation to CRP (r ¼ 0.21; Po0.05) and age (r ¼ 0.30; Po0.01). For CRP, this correlation remained significant even when adjusted for age (Po0.05). Men displaying evidence of penile arterial disease (mild and severe arterial insufficiency) were characterized by elevated CRP levels (0.17 mg/dl) compared to men with no evidence of arterial abnormalities in the penis (0.04 mg/dl). CRP levels correlate significantly with increasing severity of penile vascular disease as measured by penile Doppler.

Aging and pathogenesis of erectile dysfunction

“…Hence, it could be speculated that penile Doppler ultrasound examination detects vascular dysfunction in a very early stage. 10 These results are in accordance with previous reports of normal rigidometric parameters in patients with reduced dynamic peak systolic velocity at Doppler examination. 37 It should also be observed that the use of drugs potentially interfering with sexual function 21 increases with advancing age with the increase of prevalence of comorbid condition.…”

“…These data suggest a greater impact of vascular lesions in the pathogenesis of ED in elderly patients, confirming previous reports. 3,5,9,10,11,32 In fact, in our series, basal and dynamic peak systolic velocity at penile Doppler ultrasound examination are inversely correlated with age, as previously described. 5,36 It is noteworthy that, in our sample, the reduction of Doppler parameters is evident from the age of 40 y onwards; a previous study on a small sample of patients showed an even earlier decline of dynamic peak systolic velocity with age, which was evident from the age of 30 y.…”

“…In particular, cardiovascular and metabolic diseases with increased prevalence in the elderly (including coronary artery disease, myocardial infarction, hypertension, hyperlipidemia, diabetes mellitus and peripheral vascular disease) could play a crucial role in the pathogenesis of many cases of age-related sexual dysfunction. 3,5,[9][10][11] Considering its frequent association with cardiovascular diseases and cardiovascular risk factors, ED has been proposed as a possible marker of occult ischemic heart diseases. 3,5,11,12 Age-related modifications in endocrine function could also contribute to the increased prevalence of ED in the elderly.…”

Obesity, the metabolic syndrome, and sexual dysfunction

“…59 Additionally, reduced CRP levels, due to sustained lifestyle changes, may contribute to amelioration of erectile function, as increased CRP Obesity, the metabolic syndrome, and sexual dysfunction K Esposito and D Giugliano levels correlate significantly with reduced NO availability 60 and increasing severity of penile vascular disease as measured by penile Doppler. 61 Moreover, consistent findings support a predictive role of CRP for cardiovascular events in different populations. 62 Rapidly evolving work now demonstrates that in addition to being a marker on innate immunity, CRP also has several direct effects at the level of vessel wall.…”

Cardiovascular Risk Assessment Using High-Sensitivity C-Reactive Protein in Patients with Erectile Dysfunction

“…Of these markers, hsCRP is clearly associated with cardiovascular risk, and thus a higher hsCRP value correlates with a higher cardiovascular risk [3]. In addition, several different studies have been conducted that show an association between hsCRP levels and ED [4,5]. …”