Abstract
BackgroundDiabetics with erectile dysfunction have a high prevalence of microvascular disturbance of the coronary circuit as measured by coronary flow reserve (CFR).PurposeWe aimed to evaluate the effects of the phosphodiesterase 5 inhibitor sildenafil on CFR in diabetics with erectile dysfunction.MethodsDiabetics seeking diabetes refinement therapy were screened for vascular or neurogenic erectile dysfunction which was confirmed in 43 patients. No ischemic ECG changes were found in any of the ECG stress tests at the 100 W level. Cardiologic examinations raised suspicion of coronary artery disease in 16 patients; coronary angiography confirmed severe coronary artery lesions in 12, who were excluded from further analysis. CFR measurements were not possible in 10 participants. The 21 diabetics eligible for CFR measurements aged 60 years (50–69) had known diabetes for 11 years (3–30) and a BMI of 27 kg/m2 (24–36). CFR of the left anterior descending artery was assessed at baseline and 1 hour after 50 mg sildenafil, using transthoracic Doppler echocardiography.ResultsBaseline CFR was at the lower level of the normal range (median 245%, range 210 – 490%). After sildenafil administration, CFR decreased insignificantly (ΔCFR -10%, p = 0.3). Patients with a BMI > 25 kg/m2 and left ventricular hypertrophy exhibited the highest reduction of CFR after sildenafil. No decrease of CFR below 200 % was observed. Systemic blood pressure dropped from 130/80 mmHg to 120/72 mmHg (p < 0.002).ConclusionsDiabetics with erectile dysfunction exhibit a CFR in the lower normal range indicating severe microvascular disturbance. Sildenafil did not alter CFR in those patients. A high prevalence of severe coronary macroangiopathy was identified in asymptomatic diabetic patients screened for contraindications for sildenafil.
Highlights
Diabetic patients have a high prevalence of erectile dysfunction which is mainly caused by disturbance of the microvascular bed [1,2]
A high prevalence of severe coronary macroangiopathy was identified in asymptomatic diabetic patients screened for contraindications for sildenafil
In earlier investigations it was demonstrated that the adenosine-mediated flow reserve (CFR) of the left anterior descending (LAD) artery is reduced to values in the lower normal range in most diabetic patients, indicating disturbance of microvascular flow dynamics [7]
Summary
Diabetic patients have a high prevalence of erectile dysfunction which is mainly caused by disturbance of the microvascular bed [1,2]. This disturbance can be enhanced by hypertension, hyperlipoproteinemia and smoking, which are risk factors for macroangiopathy [3,4]. Reduction of CFR below a cut-off value of 200% is closely correlated with exercise-induced myocardial ischemia by either microvascular dysfunction or significant coronary artery stenoses [8,9]. Our aim was to evaluate whether sildenafil alters CFR in diabetics with erectile dysfunction. Diabetics with erectile dysfunction have a high prevalence of microvascular disturbance of the coronary circuit as measured by coronary flow reserve (CFR).
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
