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Early endothelial dysfunction as a marker of vasculogenic erectile dysfunction in young habitual cannabis users

International Journal of Impotence Research volume 20, pages 566–573 (2008)Cite this article

Abstract

Aim of the study was to evaluate whether endothelial dysfunction is a marker of erectile dysfunction (ED) in recreational drug abuse. Sixty-four non-consecutive men complaining of ED from at least 3 months were included. All patients underwent detailed history about recreational drug abuse and were then submitted to dynamic penile duplex ultrasound (PDU). According to pharmaco-stimulated peak systolic velocity (PSV) cutoff at 35 cm s−1, patients were divided into two groups: organic (O; n=30) and non-organic (NO; n=34) ED. All subjects and 7 healthy age-matched subjects as controls, underwent veno-occlusive plethysmography (VOP) for the evaluation of endothelium-dependent dilatation of brachial arteries. Blood pressure, total and free testosterone, prolactin, estradiol, low-density lipoprotein and high-density lipoprotein cholesterol were also evaluated; patients were classified with regard to insulin resistance through the HOMA-IR index. Cannabis smoking was more frequent in O-ED vs NO-ED (78% vs 3%, P<0.001) in the absence of any concomitant risk factor or comorbidity for ED. VOP studies revealed impaired endothelium-dependent vasodilatation in O-ED but not in NO-ED and controls (12±6 vs 32±4 and 34±5 ml min−1, respectively; P=0.003). Overall patients showed a direct relationship between HOMA-IR and PSV (r2=0.47, P<0.0001), which was maintained in men with organic ED (r2=0.62, P<0.0001). In cannabis consumers, a direct relationship between HOMA-IR and VOP was also found (r2=0.74, P<0.0001). Receiver-operating characteristic (ROC) curve analysis revealed that VOP values below 17.22 ml min−1 were suggestive for vasculogenic ED. We conclude that early endothelial damage may be induced by chronic cannabis use (and endocannabinoid system activation); insulin resistance may be the hallmark of early endothelial dysfunction and may concur to determine vascular ED in the absence of obesity. Further studies are warranted to establish a direct relationship between cannabis abuse, onset of insulin resistance and development of vascular ED.

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Author notes

  1. A Aversa and F Rossi: These authors equally contributed to this work

Authors and Affiliations

  1. Department of Medical Pathophysiology, Chair of Internal Medicine, Sapienza University of Rome, Rome, Italy

    A Aversa, F Rossi, D Francomano, R Bruzziches, C Bertone, V Santiemma & G Spera

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  1. A Aversa
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Correspondence to A Aversa.

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Aversa, A., Rossi, F., Francomano, D. et al. Early endothelial dysfunction as a marker of vasculogenic erectile dysfunction in young habitual cannabis users. Int J Impot Res 20, 566–573 (2008). https://doi.org/10.1038/ijir.2008.43

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