Subclinical vascular disease in patients with erectile dysfunction: correlation with high sensitivity C-reactive protein levels

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Background: Erectile Dysfunction (ED) may be the early clinical manifestation of a generalized vascular disease (VD) & carries an independent risk for Cardiovascular (CVS) events. Low-grade subclinical inflammation affects endothelial function & is involved in all stages of atherosclerotic process. Objectives: To test the hypothesis that,ED in men without CVS disease or its Major Risk Factors (MRF) may be the earliest sign of generalized (VD) & correlate this with high sensitivity C-reactive protein (hs-CRP) levels. Patients and methods: The current study enrolled 115 men with ED without CVS disease or its (MRF) & 40 age matched healthy men as a control group. For all participants, assessment of LV function, aortic strain (AS), distensibility (AD) & aortic wall systolic velocity(AWSV) was done using conventional echocardiography & Doppler tissue imaging. B-mode ultrasonography of common carotid & brachial arteries was performed for measurement of carotid intima-media thickness(CIMT), brachial artery flow-mediated(FMD) & nitroglycerine-mediated vasodilatation(NTGMD). Ultrasensitive immunoassay used to measure hs-CRP. Results: CIMT & hs-CRP were significantly higher in patients than controls (0.82±0.22 mm vs. 0.53±0.31 mm & 6.72±1.5 mg/L vs. 2.1±0.78 mg/L respectively, p<0.001 for all),whereas AWSV,AS & AD were significantly lower in patients compared to controls (6.1±2.1 cm/sec vs. 9.1±1.6 cm/sec, 10.6±6% vs. 17.9±7% & 7±3 cm2/dyn/103 vs. 12±5 cm2/dyn/103 respectively, p<0.001 for all). ΔFMD & FMD% that reflect endothelial function status were significantly impaired in patients when compared to controls (0.67±0.33 mm vs. 2.1±0.29 mm & 21% vs. 50% respectively, P<0.001 for each);while ΔNTGMD and NTGMD% did not differ significantly between the two groups (2.1±0.73 mm vs. 2.3±0.59 mm & 49% vs. 51% respectively, P>0.05 for each). A strong positive correlation was found between ED severity & CIMT (r=0.55), hs-CRP (r=0.6)while the correlation was negative between ED & AWSV (r= -0.83), AS (r= -0.63), AD (r= -0.65)), FMD (r= -0.85), p<0.001 for all correlations. Conclusion: Aortic, carotid & brachial artery functional parameters are all impaired in addition to elevated hs-CRP levels in patients with ED without CVS disease or its (MRF), suggesting that, ED would represent an early clinical manifestation of a diffuse systemic subclinical VD. It is, therefore, crucial to identify asymptomatic patients with ED who may be at risk of occult CVS diseases. Their early recognition may lead to treatment of risk factors & conditions associated with endothelial dysfunction, hopefully reducing the rate of major CVS events.