A Systematic Review of the Association Between Erectile Dysfunction and Cardiovascular Disease

被引:366
作者
Gandaglia, Giorgio [1 ]
Briganti, Alberto [1 ]
Jackson, Graham [2 ]
Kloner, Robert A. [3 ]
Montorsi, Francesco [1 ]
Montorsi, Piero [4 ]
Vlachopoulos, Charalambos [5 ]
机构
[1] Univ Vita Salute San Raffaele, San Raffaele Sci Inst, Dept Urol, Urol Res Inst, Milan, Italy
[2] Guys & St Thomas Hosp London, London, England
[3] Univ So Calif, Keck Sch Med, Good Samaritan Hosp, Dept Med, Los Angeles, CA 90033 USA
[4] Univ Milan, Inst Cardiol, Ctr Cardiol Monzino, Milan, Italy
[5] Athens Med Sch, Dept Cardiol 1, Athens 14575, Greece
关键词
Erectile dysfunction; Coronary artery disease; Cardiovascular diseases; Artery-size hypothesis; Screening; Phosphodiesterase type 5 inhibitors; CORONARY-ARTERY-DISEASE; SILENT-MYOCARDIAL-ISCHEMIA; TYPE-2; DIABETIC-PATIENTS; RISK-FACTORS; HEART-DISEASE; ENDOTHELIAL DYSFUNCTION; VALIDATED QUESTIONNAIRE; METABOLIC SYNDROME; MEN; EVENTS;
D O I
10.1016/j.eururo.2013.08.023
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Context: Erectile dysfunction (ED) is considered a vascular impairment that shares many risk factors with cardiovascular disease (CVD). A correlation between ED and CVD has been hypothesized, and ED has been proposed as an early marker of symptomatic CVD. Objective: To analyze the relationship between ED and CVD, evaluating the pathophysiologic links between these conditions, and to identify which patients would benefit from cardiologic assessment when presenting with ED. Evidence acquisition: A systematic literature review searching Medline, Embase, and Web of Science databases was performed. The search strategy included the terms erectile dysfunction, cardiovascular disease, coronary artery disease, risk factors, pathophysiology, atherosclerosis, low androgen levels, inflammation, screening, and phosphodiesterase type 5 inhibitors alone or in combination. We limited our search to studies published between January 2005 and May 2013. Evidence synthesis: Several studies reported an association between ED and CVD. The link between these conditions might reside in the interaction between androgens, chronic inflammation, and cardiovascular risk factors that determines endothelial dysfunction and atherosclerosis, resulting in disorders of penile and coronary circulation. Because penile artery size is smaller compared with coronary arteries, the same level of endothelial dysfunction causes a more significant reduction of blood flow in erectile tissues compared with that in coronary circulation. Thus ED could be an indicator of systemic endothelial dysfunction. From a clinical standpoint, because ED may precede CVD, it can be used as an early marker to identify men at higher risk of CVD events. ED patients at high risk of CVD should undergo detailed cardiologic assessment and receive intensive treatment of risk factors. Conclusions: ED and CVD should be regarded as two different manifestations of the same systemic disorder. ED usually precedes CVD onset, and it might be considered an early marker of symptomatic CVD. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.
引用
收藏
页码:968 / 978
页数:11
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