CVD risk elevated in vardenafil-resistant hypertensive erectile dysfunction
MedWire News: Men with hypertension and vasculogenic erectile dysfunction that fails to respond to phosphodiesterase (PDE)-5 inhibitor therapy may have an increased risk for cardiovascular disease (CVD), researchers suggest.
Indeed, in such individuals, the severity of erectile dysfunction appears to be associated with carotid intima-media thickness (IMT), while the efficacy of PDE-5 inhibitors correlates with brachial flow-mediated dilation (FMD), report Valter Javaroni (Universidade do Estado Rio de Janeiro, Brazil) and team.
They add that elevated carotid IMT and reduced brachial FMD are both indicators of increased CVD risk.
The findings, reported in the journal Urology, arise from a study involving 74 sexually active hypertensive men aged 50-70 years, with mild, moderate, or severe erectile dysfunction. An additional 26 hypertensive men without erectile dysfunction were used as controls.
Erectile dysfunction severity was determined by the International Index of Erectile Dysfunction, Erection Function Domain (IIEF-EF) score. According to this system, a score of 25 or more reflects an absence of erectile dysfunction, and a score of 18 or less reflects severe dysfunction.
Carotid IMT was measured by ultrasound and brachial FMD was detected via blood pressure measurement.
The team found that compared with controls, erectile dysfunction patients had a significantly higher mean carotid IMT (0.74 vs 0.88 mm), and a significantly lower mean FMD (10.5 vs 7.1%).
When multivariate analysis was performed, an association, albeit negative, was identified between baseline IIEF-EF score and carotid IMT. Baseline IIEF-EF score did not correlate with any other variable.
Men who responded to treatment with the PDE-5 inhibitor vardenafil, as determined by self-reported successful sexual intercourse-related erections, (n=39) had a higher brachial FMD than nonresponders (n=35), with respective degrees of FMD of 9.2% and 4.7%.
In an accompanying editorial comment, Stephen Auerbach (California Professional Research, Newport Beach, USA) remarked that these findings show that FMD can be used to predict which erectile dysfunction patients will respond best to vardenafil therapy.
In a reply to this commentary, Javaroni and co-author Mario Neves (Universidade do Estado Rio de Janeiro) wrote: "It is important not only to consider erectile dysfunction as an early marker of cardiovascular risk and a systemic vasculopathy, but also to evaluate and treat patients in the same terms."
By Lauretta Ihonor