Although the incidence and severity...

Although the incidence and severity of erectile dysfunction increases with age, the in the greatest degree common pathologic risk factor for erectile dysfunction is believed to be diabetes. Erectile function appears to hang on nitric oxide production by means of nerves and on arteriolar polished muscle relaxation. Penile artery be molten is dependent on vascular endothelial function that is compromised by the agency of other risk factors for cardiovascular disease including hyperlipidemia, smoking, and hypertension. Endothelial dysfunction can accrue from these disorders and can progres to atherosclerosis. To evaluate the correlation between erectile dysfunction severity and the standing of coronary artery disease, Solomon and associates studied the appearance and severity of erectile dysfunction in a cohort of men who underwent coronary angiography.

Participants were asked questions about erectile dysfunction using a standardized, validated erectile dysfunction measure, the International Index of Erectile Function-5 (IIEF) questionnaire, and were asked about the timing of the erectile dysfunction and their cardiovascular symptoms. Coronary artery disease was identified by way of a history of myocardial infarction, percutaneous angioplasty, coronary artery bypass grafting, or stenosis of greater than 50 percent in a coronary artery onward angiography.

Based forward verbal answers, 45 percent of the 132 make submissives noted erectile dysfunction, although 65 percent had erectile dysfunction based forward scoring of the IIEF questionnaire. Of the make subordinates who verbally reported erectile dysfunction, 58 percent noted erectile dysfunction symptoms before being diagnosed with coronary artery disease. Coronary angiography revealed that 78 percent of the bring under rules had some level of coronary artery disease. There was an inverse relationship between IIEF scores and cardiovascular risk factors and a positive relationship between the IIEF scores and use of aspirin or clopidogrel. Because a lower IIEF score means worse erectile function, these originates show that cardiovascular risk factors are positively associated with erectile dysfunction, while the use of platelet-aggregation inhibiting medications improved erectile function.

The authors finish that erectile dysfunction is associated with increased plaque weight as assessed by coronary angiogram. The fact that erectile dysfunction is a manifestation of atherosclerotic disease implies that questions about erectile dysfunction should be a part of routine cardiovascular screening, and all men with erectile dysfunction should be treated aggressively for any presenting cardiovascular risk factors.

Solomon H et al. Relation of erectile dysfunction to angiographic coronary artery disease. Am J Cardiol January 15 2003;91:230-1

EDITOR'S NOTE: In clinical practice, the evaluation and treatment of erectile dysfunction may lead to the discovery of medical co-morbidities that have been previously undiagnosed. Data support erectile dysfunction as an indicator of conditions like as diabetes, neurologic diseases, vascular disease, dyslipidemia, and coronary artery disease. Thus, erectile dysfunction depicts an opportunity for the family physician to evaluate the patient for undiagnosed co-morbidities. It has been estimated that 12 percent of patients who have diabetes are diagnosed during the evaluation of erectile dysfunction. In clinical practice, specific attention to symptoms of the like kind as polyuria, nocturia, polydipsia, and the appearance of glycosuria in the patient with erectile dysfunction may aid in the diagnosis of diabetes. Abnormal cholesterol plains have been discovered in 60 percent of men complaining of erectile dysfunction with no previous history of cardiovascular question s Asking about the presence of erectile dysfunction is a useful screening tool for rife cardiovascular disease and undiscovered risk factors.--R.S.

COPYRIGHT 2003 American Academy of Family Physicians

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