Peripheral Vascular Disorders Research Articles

Effects of moderate and severe intermittent hypoxia on vascular endothelial function and haemodynamic control in sedentary men

Acclimatization to intermittent hypoxia (IH) improves exercise performance by enhancing oxygen delivery and utilization, but the effect of IH on hemodynamic control remains unclear. This study investigates how two intensities of IH influence hemodynamic control to develop an IH regimen that improves aerobic fitness and minimizes risk of peripheral vascular disorder. Thirty healthy sedentary men were randomly divided into severe (SIH) and moderate (MIH) IH and control (C) groups. The subjects were exposed to 12% (SIH), 15% (MIH), or 21% (C) O2 for 1 h/day, 5 days/week for 4 weeks in a normobaric hypoxia chamber. The results demonstrate that (1) improved pulmonary ventilation and oxygen uptake by SIH and MIH; (2) SIH elevated blood pressure during exercise and increased plasma malondialdehyde and nitric oxide (NO) metabolite levels, accompanied by reduced hyperaemic arterial response, venous compliance, endothelium-dependent vasodilatation, and decreased plasma total antioxidant and vitamin E levels; (3) while such effects were not seen following MIH; and (4) there were no significant differences in endothelium-independent vasodilatation during all experimental periods among the three groups. We conclude that both SIH and MIH regimens improve pulmonary ventilation. However, SIH but not MIH decreases anti-oxidative capacity and increases lipid peroxidation in circulation, leading to suppression of vascular endothelial function, causing impairment of vascular haemodynamics.

Calcium channel antagonists: Clinical uses—Past, present and future

The calcium channel antagonists are a mature group of drugs directed at cardiovascular diseases including hypertension, angina, peripheral vascular disorders and some arrhythmic conditions. Their sites and mechanisms of actions have been well explored over the past two decades and their interactions at the α 1 subunit of L-type channels (Ca V1.1–1.4) have made them valuable molecular tools for channel classification and localization. With the realization that other members of the voltage-gated calcium channel family exist – Ca V2.1–2.3 and Ca V3.1–3.3 – considerable effort has been directed to drug discovery at these channel types where therapeutic prospects exist for a variety of disorders including pain, epilepsy, affective disorders, neurodegenerative disorders, etc. In contrast to the situation with the L-type channel antagonists success in developing small molecule antagonists of therapeutic utility for these other channel types has thus far been lacking. The reasons for this are explored and potential new directions are indicated including male fertility, bone growth, immune disorders, cancer and schistosomiasis.

Gene expression profiles of endothelial progenitor cells by oligonucleotide microarray analysis

Among the many tissue stem or progenitor cells recently being unveiled, endothelial progenitor cells (EPCs) have attracted particular attention, not only because of their cardinal role in vascular biology and embryology but also because of their potential use in the therapeutic development of a variety of postnatal diseases, including cardiovascular and peripheral vascular disorders and cancer. The aim of this study is to provide some basic and comprehensive information on gene expression of EPCs to characterize the cells in molecular terms. Here, we focus on EPCs derived from CD34-positive mononuclear cells of human umbilical cord blood. The EPCs were purified and expanded in culture and analyzed by a high-density oligonucleotide microarray and real-time RT-PCR analysis. We identified 169 up-regulated and 107 down-regulated genes in the EPCs compared with three differentiated endothelial cells of human umbilical vein endothelial cells (HUVEC), human lung microvascular endothelial cells (LMEC) and human aortic endothelial cells (AoEC). It is expected that the obtained list include key genes which are critical for EPC function and survival and thus potential targets of EPC recognition in vivo and therapeutic modulation of vasculogenesis in cancer as well as other diseases, in which de novo vasculogenesis plays a crucial role. For instance, the list includes Syk and galectin-3, which encode protein tyrosine kinase and beta-galactoside-binding protein, respectively, and are expressed higher in EPCs than the three control endothelial cells. In situ hybridization showed that the genes were expressed in isolated cells in the fetal liver at E11.5 and E14.5 of mouse development.

Onychomycosis: Clinico-mycologic study of 130 patients from Himachal Pradesh, India

Onychomycosis is a common nail infection caused by dermatophytes, yeast or other nondermatophyte molds and has diverse clinical presentations. Although common in this part of the country, no significant clinico-mycologic data is available. This study was carried out to document the clinico-mycologic pattern of onychomycosis in Himachal Pradesh (India). All consecutive patients of onychomycosis diagnosed clinically during March 2005 to February 2006 were studied for clinical forms, number of nails involved and severity of infection. The clippings from the most severely affected nails were subjected to potassium hydroxide (KOH) mounts for direct microscopy and fungal culture on Sabouraud's dextrose agar. These 130 patients (M:F 98:32) were between 8-76 years of age (mean 41.35 +/- 14.98 years). The prevalence of onychomycosis was higher among farmers and office workers (20% each). Finger or toe nails were exclusively involved in 56.9 and 32.3% patients respectively while these were involved concurrently in the rest of the 10.8% patients. Distal and lateral subungual onychomycosis seen in 73.1% of the specimens was the most common clinical type. KOH- and culture-positivity were recorded in 59.2 and 37.6% cases respectively. Dermatophytes and yeast (Candida albicans) were isolated in 40.8% each of the cultured nail specimens while nondermatophytic molds (NDM) were cultured in 18.6% of the samples. Various dermatophytes cultured were Trichophyton rubrum (32.6%), T. mentagrophytes (6.1%) and T. verrucosum (2.1%) respectively. Aspergillus spp. (6.1%) was the most commonly isolated NDM while other detected molds were Acremonium spp, Fusarium spp,, Scopulariopsis spp, Curvularia spp. and Penicillium marneffei. Peripheral vascular disorders (7.69%), occupational trauma (13.8%), close association with animals (60.78%) and a family history of onychomycosis (26.15%) were a few of the predisposing factors identified. Onychomycosis is not uncommon in this part of the country and has similar clinico-mycologic profiles in the different cases detected.

Examination of the Utility of Skin Perfusion Pressure Measurements in Diabetic Peripheral Vascular Disorders

Examination of the Utility of Skin Perfusion Pressure Measurements in Diabetic Peripheral Vascular Disorders

Guidelines for Noninvasive Vascular Laboratory Testing: A Report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology

Accompanying the rapid growth of interest inpercutaneous vascular interventions, there hasbeen increasing interest among cardiologists inperforming noninvasive vascular testing using ul-trasound. In an attempt to provide recommenda-tions on the best practices in vascular laboratorytesting, this report has been prepared by a writinggroup from the American Society of Echocardiog-raphy (ASE) and the Society of Vascular Medicineand Biology. The document summarizes principlesintegral to vascular duplex ultrasound–includingcolor Doppler, spectral Doppler waveform analy-sis, power Doppler, and the use of contrast.Appropriate indications and interpretation of ca-rotid artery, renal artery, abdominal aorta, andperipheral artery ultrasound imaging are de-scribed. A dedicated section summarizes noninva-sive techniques for physiologic vascular testing ofthe lower extremity arteries–including measure-ment of segmental pressures and pulse volumeplethysmography. The use of exercise testing inthe evaluation of peripheral artery disease, ultra-sound evaluation of the lower extremities afterpercutaneous revascularization, and the diagnosisand management of iatrogenic pseudoaneurysm(PSA) is also discussed. A section on the importanttopic of vascular laboratory accreditation is in-cluded. Finally, additional details regarding propertechnique for performance of the various vasculartests and procedures are included in the Appen-dix.

Occupational hand–arm vibration syndrome in Korea

It is suspected that there is a large number of patients suffering from hand-arm vibration syndrome (HAVS) in Korea. However, no cases have been reported since 1992. This study was conducted to identify HAVS cases and determine the characteristics of the syndrome. In April 2001, the Busan, Ulsan, and Gyeong-Nam Province Occupational Disease Surveillance System (BUGODSS) was established to identify work-related HAVS and other occupational diseases. In the 2 years of this project, occupational physicians from five hospitals in these provinces collected information by way of interviews and questionnaires during mandatory occupational medical examinations. Among the initial 189 suspected HAVS cases, 58 volunteers were given cold-water provocation tests in order to diagnose the vascular component of the disorder. One hundred fifty-four approximately occupational HAVS cases were identified from ca. 21,000 workers. One hundred fifty about of these cases were male. The cases were most often found in workers from the shipbuilding industry, and the grinder was the most common source of vibration exposure. Cases of sensorineural disorder (SD) were more common than cases of vascular disorder (VD). The mean values of the finger skin temperature and its recovery rate at 5 min and 10 min after cold-water provocation were significantly lower in the group with the VD than in the group with the SD. We identified 154 occupational HAVS cases, although no cases have been reported during the occupational medical examinations mandated by the state. The majority of the cases were in workers that used grinders in the shipbuilding industry. We determined that peripheral VD and peripheral SD can progress independently of each other. We conclude that exposure to hand-transmitted vibration (HTV) and HAVS cases are common in shipbuilding industry in Korea. The recovery rate of finger skin temperature after cold-water provocation is one of the useful methods for diagnosing the vascular component of HAVS.

Determination of Urinary Trace Elements (Arsenic, Copper, Cadmium, Manganese, Lead, Zinc, Selenium) in Patients with Blackfoot Disease

To determine the relationship of arsenic, copper, cadmium, manganese, lead, zinc and selenium to Blackfoot disease (BFD, a peripheral vascular disorder endemic to areas of Taiwan, which has been linked to arsenic in drinking water) the authors measured the amount of these substances in urine from BFD patients, using atomic absorption spectrometry. Results indicate significantly higher amounts of urinary arsenic, copper, cadmium, manganese, and lead for BFD patients than for normal controls, also significantly lower urinary zinc and selenium.

Pain Medicine: A Comprehensive Review.

Pain Medicine: A Comprehensive Review. By P. Prithvi Raj, M.D. St. Louis, Mosby, 2003. ISBN: 0323014704. Pages: 430. Price: $89.95.It is a pleasure to see a new edition of this comprehensive pain medicine review, as the first edition received widespread acclamation among pain specialists, fellows, and residents. The authors’ goal is to provide a concise but comprehensive review of the latest theories and modalities available in pain medicine that have practical value in daily pain practice. They deserve congratulations in fulfilling their mission.This edition encompasses a total of 430 pages covering 36 chapters in 6 parts. Current practice includes a wide spectrum of approaches to care. While some practitioners choose the conservative end of this spectrum, others tend to be more invasive. One of the strong points of the second edition is the collaboration of 72 different pain medicine authorities that represent a variety of views. Despite the numerous authors, the style, message, and flow of the book have not been jeopardized. For example, the chapter on neuropathic pain clearly describes and differentiates central versus peripheral nervous system pain and briefly explains the main characteristics of each pathologic condition. It also touches on a range of therapeutic options, from conservative approaches such as acupuncture and physical therapy for phantom limb pain, to invasive interventional techniques such as gasserian ganglion block for trigeminal neuralgia.The book begins by introducing the basics of pain medicine to the reader and smoothly builds up his or her knowledge of acute and chronic pain syndromes, evaluation and investigation of pain patients, and modalities of pain management. The majority of chapters are equipped with highly informative tables and schematic illustrations that summarize each chapter reliably, but the paucity of fluoroscopic imaging is a limitation. Visualization of the actual fluoroscopic images could have been of great assistance for readers in addition to the well-described theoretical points of interventional pain management techniques. Inclusion of fluoroscopic views could have made the book more powerful.Although the breadth of coverage is for the most part admirable, it is perhaps inevitable in such a diverse field that some topics receive incomplete coverage. For example, spinal cord stimulators originally were designed for management of the reflex sympathetic dystrophy and neuropathic pain. Currently, the indications for spinal cord stimulators have expanded to include conditions such as failed back surgery syndrome, inoperable peripheral vascular disorders, ischemic heart disease, and others. Unfortunately, this book does not quench the thirst of an enthusiastic reader to learn the basics of spinal cord stimulators and their indications, placement, and complications. However, deficiencies such as this are few.Chronic pain management is a complex and delicate matter. A large number of patients live with years of suffering and disappointment. Long-term suffering and work-related issues may make certain individuals litigious. Therefore, medicolegal issues are becoming more prominent in pain medicine, and they must be properly addressed. That is why part 6 (special situations) of this book is an invaluable addition. It focuses on economics of pain medicine, pain medicine and the legal system, ethical issues in pain management, and other sensitive areas that are crucial for a successful practice.In summary, this is a priceless review book for your library no matter the level of your knowledge and training. As a resident, you can review this book quickly to get an idea about the daily practice of pain medicine. As a pain fellow, you can use this book to summarize your readings before sitting for the boards. As a practicing pain specialist, you are simply obligated to own all of Dr. Raj’s works!

Imagerie diagnostique de la pathologie vasculaire rénale périphérique

Peripheral vascular disorders of the kidney involve the intrarenal branches of the renal vascular tree. It include occlusive (infarction and cortical necrosis) and non-occlusive vascular lesions (acquired arteriovenous fistulas, arteriovenous malformation, false aneurysms and microaneurysms). Initial diagnosis relies on color Doppler US and CT angiography. Angiography plays a therapeutic role. MR imaging provides useful diagnostic information on perfusion disorders especially in patients with renal insufficiency.

Prevalence and risk factors for erectile dysfunction in a population-based study in Iran.

To explore the prevalence of and risk factors for erectile dysfunction (ED) in Iran. A total of 2674 men aged 20-70 y old were interviewed by 42 general practitioners and answered a self-administered questionnaire. The subjects were randomly identified from 28 counties of Iran. ED was defined as difficulties in achieving an erection before sexual intercourse and maintaining it. Data on medical history, toxic habits, and current use of medications were also obtained. Of the men interviewed, 18.8% (460) reported ED. Impotence was found to be significantly associated with age and was less associated with geographical location. The prevalence increased with age, from 6% in men 20-39 y to 47% in those >60 y (tested for trend < or = 0.001). A history of diabetes (odds ratio (OR) 3.72, 95% confidence interval (CI), 2.51-5.71), hypertension (OR 1.69, 95% CI, 1.31-2.40), peripheral vascular disorders (OR 2.44, 95% CI, 1.65-3.74), hypercholesterolemia (OR 1.71, 95% CI, 1.11-2.65), and coronary artery disease (OR 1.61, 95% CI, 1.21-2.85) were significantly associated with ED. In comparison with never smokers, the OR of ED was 2.41 (95% CI, 1.52-3.30) for current smokers and 2.15 (95% CI, 1.38-3.1) for ex-smokers and increased with duration of the habit. Drug intake, called tranquilizers and antidepressants, correlated strongly (OR 3.71, 95% CI, 2.51-6.76 and OR 2.80, 95% CI, 1.47-4.32, respectively). This study provides a quantitative estimate of the prevalence and main risk factors for ED in Iranian men.

Nitric oxide in uremia: Effects of several potentially toxic guanidino compounds

Vascular and neurologic impairment remain an important source of morbidity in patients with chronic renal failure (CRF). A portion of CRF patients still suffers from uremic encephalopathy or other signs of nervous system impairment. Several reports demonstrate increased incidence of cardiac infarction and cerebrovascular accidents in CRF patients, even in those with otherwise adequate dialysis treatment [1]. Premature vascular disease, including myocardial infarction, stroke, and peripheral vascular disorder, are the leading causes of death in this population. Although several traditional risk factors for vascular disease and endothelial dysfunction, including smoking, diabetes, dyslipidemia, and hypertension, are often increased in CRF, these factors can only partly explain the high vasculopathy-related morbidity and mortality. Several authors have postulated that CRF-associated atherosclerosis and endothelial dysfunction result from accumulation of certain 'uremic factors,' the identities of which are still a matter of debate. These factors include a variety of guanidino compounds (GCs), which have been shown to be nitric oxide synthase (NOS) modulators both in vitro and in vivo. However, other effects of accumulated uremic GCs have been identified.

The Renal Palliative Care Initiative.

Despite ongoing technological advances, patients with end-stage renal disease (ESRD) have a mortality rate of approximately 23% per year, and comorbid cardiovascular, cerebrovascular, and peripheral vascular disorders often make life on dialysis an ordeal. This patient population needs an improved approach to symptom assessment and control, as well as advance care planning and high-quality palliative care. Families need support during the lifetime and after the death of their loved ones. To address these needs, the Renal Palliative Care Initiative (RPCI) was instituted at Baystate Medical Center, a large tertiary care hospital, and at eight dialysis clinics in the Connecticut River Valley. With the cooperation of a large nephrology practice, the Western New England Renal and Transplant Associates, a core group of physicians, nurses, and social workers were trained in palliative medicine, and charged with the goals of developing and implementing innovative interventions. The RPCI's programs include symptom management protocols, advance care planning, and bereavement services for families and staff. The Initiative is increasing completion of formal advance directives by the patient population, while staff and families are particularly pleased with annual renal memorial services. The RPCI experience has much to offer the practice of nephrology, and it is relevant to ongoing efforts to extend palliative medicine beyond the traditional focus on cancer and AIDS.

Potential Use of MR Angiography for Diagnosis and Postinterventional Follow-Up of a Posttraumatic Arteriovenous Fistula

Background: Arteriovenous fistulae represent a common sequel following injury to blood vessels. They can be assessed by several ways including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and conventional angiography. MRI has proven to be a useful technique in the visualization of the extent of vascular disorders. However, magnetic resonance angiography (MRA) has not yet been established as a standard modality for evaluation of feeding and draining vessels. Case Study: We report on the case of a 32-year-old man suffering from a clinically symptomatic vascular fistula following inguinal stabbing in order to present the role of contrast-enhanced MRA for diagnosis and postinterventional follow-up of a peripheral vascular disorder.

High-resolution CT and CT angiography of peripheral pulmonary vascular disorders.

Peripheral pulmonary vascular disorders that can be evaluated with computed tomography (CT) include various disease entities with overlapping imaging features and a wide range of clinical manifestations. The overall accuracy of CT in the diagnosis of pulmonary vascular disorders increases with improved spatial resolution, administration of a high-flow contrast material bolus, and the use of cardiac gating. The integration of high-resolution CT and CT angiographic techniques into one scanning protocol has important clinical implications for multisection CT and makes it the imaging modality of choice in the evaluation of this complex group of disorders.

Off-pump coronary artery bypass grafting decreases morbidity and mortality in a selected group of high-risk patients

Background. The ideal indication for off-pump coronary artery bypass grafting (OPCABG) has yet to be defined. High-risk surgical patients may benefit the most when cardiopulmonary bypass (CPB), aortic cross clamping, and cardioplegic arrest are avoided. The aim of this study was to determine whether off-pump coronary artery bypass grafting might decrease the operative morbidity and mortality in a select group of high-risk patients with multivessel coronary artery disease. Methods. Utilizing a Parsonnet risk stratification model we analyzed prospectively collected data on a cohort of high-risk coronary artery disease patients, which were operated on with beating-heart technology by the same group of surgeons in a tertiary care university medical center. High-risk patients were defined as those with a Parsonnet score of 15 or greater. Results. Fifty-seven multivessel disease OPCABG patients (over a period of 2 years) had markedly increased Parsonnet scores (24.3 ± 10.6). The average ejection fraction of the patients was 42% (±12.3) and their age ranged from 52 to 85 years (mean 70.6 ± 10.4, 26% women). Unstable angina was present in 42 patients (74%) and 10 patients underwent OPCABG within 24 hours of the occurrence of acute myocardial infarction. In addition to severe coronary artery disease 32% of the patients presented with congestive heart failure, insulin-dependent diabetes (18%), renal failure (22%), peripheral vascular disease (31%), pulmonary disease (18%), and neurologic disorders (14%). An average of 2.6 ± 0.9 grafts/patient were performed and the posterior descending artery or marginal branches of the circumflex artery or both were grafted in 90%. The 30-day mortality rate was 3.5% (n = 2). Conclusions. OPCABG can be performed with a reasonable low morbidity and mortality in this select group of high-risk patients. OPCABG is a reasonable, and might even be preferable, operative strategy in this high-risk group of patients.

Peripheral vascular diseases resulting from chronic arsenical poisoning.

Drinking water contaminated by arsenic remains a major public health problem. Long-term arsenic exposure has been found to be associated with peripheral vascular diseases in a variety of studies. Reports of vascular effects of arsenic in drinking water, which span almost 100 years, have been published in Taiwan, Chile, Mexico, and China. This paper reviewed the association of peripheral vascular diseases resulting from arsenic exposure to drinking water from the clinical and pathological points of view. An endemic peripheral vascular disorder called "blackfoot disease" has been noticed in a limited area in Taiwan. This disease results in gangrene in the extremities. It has been associated with the ingestion of high concentrations of arsenic-tainted artesian well water. Epidemiological studies confirmed a dose-response relationship between long-term arsenic exposure and the occurrence of blackfoot disease. Whereas arsenic has induced various clinical manifestations of vascular effects in Chile, Mexico and China, they do not compare in magnitude or severity to the blackfoot disease found in Taiwan. The pathogenesis of vascular effects induced by arsenic is still controversial. The possible mechanisms include endothelial cell destruction, arsenic-associated atherogenesis, carotene and zinc deficiency, and/or some immunological mechanism. Microcirculatory assessments revealed that deficits of capillary blood flow and permeability exist in clinically normal skin of patients with chronic arsenical poisoning. The vascular effects of chronic arsenic poisoning may involve cardiovascular and cerebrovascular systems as well. In view of the increasing public health problems caused by arsenic exposure, vascular effects should be included in the future study of health effects of arsenic.

Neurosurgical approaches to pain treatment.

In a multidisciplinary approach to the management of chronic pain, neurosurgical methods are an indispensable part of the therapeutic armamentarium. With the exception of percutaneous interventions for trigeminal neuralgia and facet joint syndromes, most ablative pain surgery procedures (neurotomy, rhizotomy, sympathectomy, etc.) have been replaced by neuromodulatory approaches such as electrical stimulation of the central nervous system (CNS). However, cordotomy is still a valuable operation for certain forms of cancer related pains (Pancoast's syndrome, breakthrough pain) which are relatively resistant to pharmacotherapy. Another example of ablative surgery is the dorsal root entry zone (DREZ) operation, which is generally the only treatment option for pain due to root avulsion and segmental pain in spinal cord injury. Spinal cord stimulation (SCS) has proven to be most useful for the management of pain following peripheral nerve injury (including complex regional pain syndromes) and rhizopathy. For these conditions which are otherwise often therapy resistant, SCS may produce substantial and long-lasting pain relief in 60-70% of the patients. Considering that such pains are common and the fact that SCS has been shown to be cost-effective, this treatment is no doubt at present underused. Complications and side-effects are very rare. SCS has also been found to be useful for pain in peripheral vascular disorders and angina pectoris. In the latter condition the overall results are favorable in about 80% of patients with a significant reduction of the frequency and severity of angina attacks and the need for nitrates. Stimulation of the motor cortex is a novel and promising treatment of central, post-stroke pain and painful trigeminal neuropathy.

Viability of Diced, Crushed Cartilage Grafts and the Effects of Surgicel (Oxidized Regenerated Cellulose) on Cartilage Grafts

The use of tobacco is a significant contributor to preventable morbidity and mortality in the United States. A significant proportion of cardiovascular diseases, various oral and pulmonary neoplasms, nonmalignant respiratory diseases, and peripheral vascular disorders can be attributed to the use of cigarettes. Surgical outcomes can also be adversely affected as a result of cigarette smoking with intraoperative and postoperative pulmonary, cardiovascular, and cerebrovascular complications as well as increased wound healing complications. These are found across the entire spectrum of surgical specialties. Tissue ischemia and wound-healing impairment secondary to the influence of tobacco is particularly problematic for the plastic surgeon, especially during elective facial aesthetic procedures, cosmetic and reconstructive breast operations, abdominoplasty, free-tissue transfer, and replantation procedures. By educating and providing guidelines to those patients who smoke and by refusing to operate on individuals who fail to abstain, tobacco-associated surgical morbidity in the plastic and reconstructive surgery patient can be eliminated.

PREVALENCE AND INDEPENDENT RISK FACTORS FOR ERECTILE DYSFUNCTION IN SPAIN: RESULTS OF THE EPIDEMIOLOGIA DE LA DISFUNCION ERECTIL MASCULINA STUDY

We determined the prevalence of and risks factors for erectile dysfunction in Spain in a cross-sectional study. A total of 2,476 noninstitutionalized Spanish men 25 to 70 years old were interviewed at home and answered a self-administered questionnaire of 71 items, including 2 instruments to define erectile dysfunction, a simple self-assessment question to estimate erectile function and the International Index of Erectile Function. Data on disease, medication and toxic habits were also obtained. With an overall participation rate of 75% the prevalence of erectile dysfunction according to the simple question was 12.1%. According to the erectile function domain of the International Index of Erectile Function the overall prevalence was 18.9%. Several independent risk factors were significantly associated with the probability of erectile dysfunction. Some differences arose according to the tool used to define the condition. However, there was a strong relationship of patient age with frequency or severity no matter which instrument was used to define erectile dysfunction. Diabetes (age adjusted odds ratio 4), high blood pressure (odds ratio 1.58), high cholesterol (1.63), peripheral vascular disorder (2.63), lung disease (3.11), prostate disease (2.93), cardiac problems (1.79), rheumatism (2.37) and allergy (3.08) were significantly associated with erectile dysfunction. Drug intake, which respondents called medication for nerves and sleeping pills, correlated strongly (odds ratio 2.78 and 4.27, respectively), as did tobacco use (2.5) and alcohol consumption (1.53). This study provides data on the prevalence of and risks factors for erectile dysfunction in Spain. The relationship of erectile dysfunction with certain risk factors, such as cardiovascular risk factors and drugs intake, are well known and our study corroborates these associations. Other associations with erectile dysfunction, such as prostate disease, allergy and rheumatism, support findings in previous reports, although to our knowledge the pathophysiological mechanisms remain unclear. Estimating the strength of the association of erectile dysfunction with distinct risk factors in terms of odds ratios enabled us to identify the factors to pursue when seeking to prevent erectile dysfunction. Furthermore, the relationship of tobacco with erectile dysfunction, which has been controversial in previous series, was well characterized in our study.