Abstract
Penile erection is a neurovascular process controlled by numerous tightly regulated events, and occurs in response to the activation of pro-erectile autonomic pathways. It is dependent on an adequate inflow of blood to the erectile tissue through both endothelium-dependent vasodilatation and corporal smooth muscle relaxation. Pathologic alteration in the endothelium of penile vasculature and/or erectile tissue and/or impairment of neurovascular processes can result in erectile dysfunction (ED). Both cardiovascular disease (CVD) and ED have been linked to endothelial dysfunction. Endothelial dysfunction is a vascular condition resulting in a diminished vasodilatory response to pharmacologic and physiologic stressors. Endothelial dysfunction may be a pathophysiologic mechanism underlying both ED and CVD, forming a unifying link between these two conditions. Furthermore, in the general population and in men with diabetes or obesity, ED may be a valuable early marker for serious subclinical CVD, coronary artery disease and atherosclerosis.
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References
Burnett AL . Nitric oxide in the penis—science and therapeutic implications from erectile dysfunction to priapism. J Sex Med 2006; 3: 578–582.
Dean RC, Lue TF . Physiology of penile erection and pathophysiology of erectile dysfunction. Urol Clin North Am 2005; 32: 379–395.
Lue TF . Erectile dysfunction. N Engl J Med 2000; 342: 1802–1813.
Bivalacqua TJ, Usta MF, Champion HC, Kadowitz PJ, Hellstrom WJG . Endothelial dysfunction in erectile dysfunction: role of the endothelium in erectile physiology and disease. J Androl 2003; 24 (Suppl 6): S17–S37.
Prieto D . Physiological regulation of penile arteries and veins. Int J Impot Res 2008; 20: 17–29.
Furchgott RE, Zawadzki JV . The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature 1980; 288: 373–376.
Behrendt D, Ganz P . Endothelial function: from vascular biology to clinical applications. J Am Coll Cardiol 2002; 90: 40L–48L.
Maxwell AJ . Mechanisms of dysfunction of the nitric oxide pathway in vascular diseases. Nitric Oxide 2002; 6: 101–124.
Kendirci M, Nowfar S, Hellstrom AJG . The impact of vascular risk factors on erectile function. Drugs of Today 2005; 41: 65–74.
Selvin E, Burnett AL, Platz EA . Prevalence and risk factors for erectile dysfunction in the US. Am J Med 2007; 120: 151–157.
Toda N, Ayajiki K, Okamura T . Nitric oxide and penile erectile function. Pharmacol Ther 2005; 106: 233–266.
Carson CC, Lue TF . Phosphodiesterase type 5 inhibitors for erectile dysfunction. BJU Int 2005; 96: 257–280.
Hurt KJ, Musicki B, Palese MA, Crone JK, Becker RE, Moriarity JL et al. Akt-dependent phosphorylation of endothelial nitric-oxide synthase mediates penile erection. Proc Natl Acad Sci USA 2002; 99: 4061–4066.
NIH Consensus Development Panel on Impotence. NIH Consensus Conference: impotence. JAMA 1993; 270: 83–90.
Seftel AD, Sun P, Swindle R . The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol 2004; 171: 2341–2345.
Kubin M, Wagner G, Fugl-Meyer AR . Epidemiology of erectile dysfunction. Int J Impot Res 2003; 15: 63–71.
Ayta A, McKinlay JB, Krane RJ . The likely world-wide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int 1999; 84: 50–56.
Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB . Incidence of erectile dysfunction in men 40–69 years old: longitudinal results from the Massachusetts male aging study. J Urol 2000; 163: 460–463.
Prins J, Blanker MH, Bohen AM, Thomas S, Bosch JL . Prevalence of erectile dysfunction: a systematic review of population-based studies. Int J Impot Res 2002; 14: 422–432.
Lindau ST, Schumm P, Laumann EO, Levnison W, O'Muircheartaigh CA, Waite LJ . A study of sexuality and health among older adults in the United States. N Engl J Med 2007; 347: 762–774.
Grover SA, Lowensteyn I, Kaouache M, Marchand S, Coupal L, DeCarolis E et al. The prevalence of erectile dysfunction in the primary care setting: importance of risk factors for diabetes and vascular disease. Arch Intern Med 2006; 166: 213–219.
Kuvin JT, Karas RH . Clinical utility of endothelial function testing: ready for prime time? Circulation 2003; 107: 3243–3247.
Taddei S, Virdis A, Mattei P, Ghiadoni L, Gennari A, Fasolo CB et al. Aging and endothelial function in normotensive subjects and patients with essential hypertension. Circulation 1995; 91: 1981–1987.
Kirby M, Jackson G, Betteridge J, Friedli K . Is erectile dysfunction a marker for cardiovascular disease? Int J Clin Pract 2001; 55: 614–618.
Thompson IM, Goodman PJ, Tangen CM, Lucia MS, Miller GJ, Ford LG et al. The influence of finasteride on the development of prostate cancer. N Engl J Med 2003; 349: 215–224.
Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA . Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005; 294: 2996–3002.
Sullivan ME, Keoghane SR, Miller MAW . Vascular risk factors and erectile dysfunction. BJU Int 2001; 87: 838–845.
Gazzaruso C, Giordanetti S, De Amici E, Bertone G, Falcone C, Geroldi D et al. Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation 2004; 110: 22–26.
Giugliano F, Esposito K, Di Palo C, Ciotola M, Giugliano G, Marfella R et al. Erectile dysfunction associates with endothelial dysfunction and raised proinflammatory cytokine levels in obese men. J Endocrinol Invest 2004; 27: 665–669.
Esposito K, Giugliano F, Ciotola M, De Sio M, DiArmiento M, Giugliano D . Obesity and sexual dysfunction, male and female. Int J Impot Res 2008; 20: 358–365.
Mulhall J, Telokem P, Brock G, Kim E . Obesity, dyslipidemias and erectile dysfunction: a report of a subcommittee of sexual medicine society of North America. J Sex Med 2006; 3: 778–786.
Chiurlia E, D'Amico R, Ratti C, Granata AR, Romagnoli R, Modena MG . Subclinical coronary artery atherosclerosis in patients with erectile dysfunction. J Am Coll Cardiol 2005; 46: 1503–1506.
Billups KL, Bank AJ, Padma-Nathan H, Katz S, Williams R . Erectile dysfunction is a marker for cardiovascular disease: results of the Minority Health Institute Expert Advisory Panel. J Sex Med 2005; 2: 40–52.
Acknowledgements
The author would like to acknowledge medical writing support by Jackie Phillipson of Gardiner-Caldwell Communications; this support was funded by Eli Lilly and Company. Diane Stothard (Eli Lilly and Company) provided support by reviewing this article.
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The author is a paid consultant for Pfizer, Eli Lilly and Company and an investigator for Pfizer and Bayer.
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Giuliano, F. New horizons in erectile and endothelial dysfunction research and therapies. Int J Impot Res 20 (Suppl 2), S2–S8 (2008). https://doi.org/10.1038/ijir.2008.46
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DOI: https://doi.org/10.1038/ijir.2008.46
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