The effect of vardenafil on endothelial function of brachial and cavernous arteries

Abstract

The aim of the present study was to examine the effect of new phosphodiesterase type 5 inhibitor vardenafil on endothelial function of cavernous and brachial arteries in healthy men and in patients with different forms of erectile dysfunction (ED). This prospective, double-blind, placebocontrolled study was performed on 135 men with ED and 30 healthy controls. Complex evaluation was performed in all patients with ED. All participants also underwent our modification of ultrasound (US) assessment of postocclusive changes in the diameter of cavernosal arteries and endothelium-dependent flow-mediated dilation (FMD) of the brachial artery before and 1 h after administration of 20 mg of vardenafil or placebo. After study drug administration, PICAD and FMD significantly increased in patients receiving vardenafil (Po0.001) but not in patients receiving placebo. Increase in PICAD values was significantly greater in patients with arteriogenic ED compared with patients with organic nonarterial ED (P ¼ 0.007), psychogenic ED (Po0.001) and controls (P ¼ 0.001). The most prominent increase in brachial artery FMD values were found in patients with arteriogenic ED, although statistically significant differences were present only between patients with arteriogenic ED and control group (P ¼ 0.035). We have found a moderate negative correlation between initial PICAD and its increase after vardenafil and between pretreatment flow-mediated vasodilation of brachial arteries and its increase after vardenafil administration (r ¼ À0.57 and À0.55, respectively). These findings suggest that the use of vardenafil restores impaired endothelial function of cavernous and brachial arteries.

The endothelial cell in health and disease: its function, dysfunction, measurement and therapy

“…Interestingly, patients with arteriogenic ED (assessed by Doppler ultrasonography with intracavernosal prostaglandin E1 injection) showed greater increases in cavernous versus brachial artery dilation in response to a PDE5 inhibitor and no correlation was found between cavernous and brachial arteries. 83,84 This report 84 indicates that for diagnosing arteriogenic ED, measuring FMD in cavernous arteries is highly sensitive and specific and is superior to measuring FMD in the brachial artery. Various methods of endothelial function measurement are being used in research studies to establish and further elucidate the link between endothelial dysfunction and ED 4,6,8,9,[85][86][87][88] with the goal of establishing a simple diagnostic test for vasculogenic ED.…”

“…82 Endothelialdependent vasodilation of the cavernous arteries is being elicited using a special sphygmomanometric cuff inflated at the base of the penis to suprasystolic pressure for 5 min, similar to blood pressure cuffinduced FMD of the brachial artery. Using these methods Mazo et al 83,84 showed that a PDE5 inhibitor increased FMD in both penile and brachial arteries. Interestingly, patients with arteriogenic ED (assessed by Doppler ultrasonography with intracavernosal prostaglandin E1 injection) showed greater increases in cavernous versus brachial artery dilation in response to a PDE5 inhibitor and no correlation was found between cavernous and brachial arteries.…”

“…Various methods of endothelial function measurement are being used in research studies to establish and further elucidate the link between endothelial dysfunction and ED 4,6,8,9,[85][86][87][88] with the goal of establishing a simple diagnostic test for vasculogenic ED. [80][81][82][83][84][89][90][91] Clinical implications of endothelial function testing…”

Assessment of endothelial function in the patient with erectile dysfunction: an opportunity for the urologist

“…Very recently, several groups 99,100 have demonstrated that the severity of the endothelial dysfunction correlated with ED etiology. Endothelial function was significantly worse in subjects with arteriogenic ED as demonstrated by penile Doppler than in patients with other forms of ED (psychogenic, venous occlusive dysfunction).…”

Erectile dysfunction and heart failure: the role of phosphodiesterase type 5 inhibitors

“…The three PDE-5 inhibitors each reduce endothelial dysfunction. [3][4][5][6] As a result of the endothelial dysfunction that can occur with some types of ED, links between cardiovascular diseases and ED have been discovered. 7,8 ED is associated with coronary artery disease, 9 hypertension 10 and now heart failure (HF).…”