The Triad of Endothelial Dysfunction, Cardiovascular Disease, and Erectile Dysfunction: Clinical implications

Context: Evidence is accumulating in favor of erectile dysfunction (ED) as a vascular disorder in the vast majority of patients. Endothelial dysfunction is the initial step of the atherosclerotic process involving many vascular districts, including penile and coronary circulation. Objective: To make a holistic and comprehensive approach to the proposed triad of endothelial dysfunction-cardiovascular disease (CVD)-ED and its clinical implications. Evidence acquisition: A MedLine search of the dates January 1980 to July 2008 was performed that included original and review manuscripts articles with focus on anatomic, physiologic, epidemiologic, and clinical outcomes. Evidence synthesis: There is room to consider ED as a marker of early subclinical coronary artery disease (CAD). Moreover, ED is an independent predictor of future cardiovascular (CV) events. Noninvasive tests assessing the endothelium integrity are the flow-mediated dilation of the brachial artery and the circulating endothelial activated cells. Conclusions: The onset of sexual dysfunction should be considered as a marker of subclinical systemic vascular disease and has been found to predict subsequent CV events. It is, therefore, crucial to identify asymptomatic patients with ED who may be at risk of occult CAD. Their early recognition may lead to treatment of risk factors and conditions associated with endothelial dysfunction, hopefully reducing the rate of major CV events. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.