Korean J Urol.  2006 Aug;47(8):859-865. 10.4111/kju.2006.47.8.859.

The Efficacy of the Intima-media Thickness (IMT) to Predict Cardiovascular Disease in Vasculogenic Erectile Dysfunction Patients

• Kwon ST
• Yoon CJ
• Moon KH

• KMID: 2294115
• DOI: http://doi.org/10.4111/kju.2006.47.8.859

Abstract

PURPOSE: Erectile dysfunction (ED) is associated and might be one of the first signs of cardiovascular disease (CVD). We aimed to assess whether men with vasculogenic ED have an increased risk of CVD by evaluating the relationship between erectile function and the intima-media thickness (IMT) of the common carotid arteries.
MATERIALS AND METHODS
A total of 40 men were divided into 4 groups according to their erectile function as evaluated by the International Index of Erectile Function (IIEF)-15 and the presence of vascular risk factors (VRF). The risk free (RF) group (n=10) included men with ED and no evidence of VRF, the low-risk (LR) group (n=10) included the vasculogenic ED subjects who were overweight or dyslipidemic, and high-risk (HR) group (n=10) consisted of ED subjects with hypertension or diabetes. An age-matched healthy group without ED served as the control (n=10). Blood pressure, height, weight, the lipid profile and the IMT of the carotid arteries were evaluated.
RESULTS
The control group and the vasculogenic ED groups showed significant differences in the IIEF scores and IMT (p<0.05). Spearman's test of the entire subjects revealed a significant correlation between the severity of ED and IMT (p<0.01), which was not present in the control group (p=0.523). However, a significant correlation of the severity of ED and IMT was found in the groups with ED (p<0.05). In addition, the evaluated parameters of the control group and the RF group revealed no significant difference except for the IIEF scores.
CONCLUSIONS
Our results suggest that ED might be a prodrome of cardiovascular diseases. Thus, screening on cardiovascular risk factors and taking preventive measures are considered in ED patients, especially if the ED is severe.

Keyword

Erectile dysfunction; Cardiovascular disease; Initmal thickness

MeSH Terms

Blood Pressure
Cardiovascular Diseases*
Carotid Arteries
Carotid Artery, Common
Erectile Dysfunction*
Humans
Hypertension
Male
Mass Screening
Overweight
Risk Factors

Figure

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  Fig. 1 Distribution of the IMT and IIEF scores among the entire study group. IMT: intima-media thickness, IIEF: International Index of Erectile Function, Spearman's test p=0.001, Spearman's correlation coefficient: -0.567.

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  Fig. 2 Distribution of the IMT and IIEF scores among the controls. IMT: intima-media thickness, IIEF: International Index of Erectile Function, Spearman's test p=0.523.

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  Fig. 3 Distribution of IMT and IIEF scores among the erectile dysfunction groups (RF, LR and HR). IMT: intima-media thickness, IIEF: International Index of Erectile Function, Spearman's test p=0.034, Spearman's correlation coefficient: -0.476.

Reference

1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging study. J Urol. 1994. 151:54–61.

2. Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB, et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med. 2000. 30:328–338.

3. Bortolotti A, Parazzini F, Colli E, Landoni M. The epidemiology of erectile dysfunction and its risk factors. Int J Androl. 1997. 20:323–334.

4. Roumeguere T, Wespes E, Carpentier Y, Hoffmann P, Schulman CC. Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk. Eur Urol. 2003. 44:355–359.

5. Kloner RA. Erectile dysfunction in the cardiac patient. Curr Urol Rep. 2003. 4:466–471.

6. Kawanishi Y, Lee KS, Kimura K, Koizumi T, Nakatsuji H, Kojima K, et al. Screening of ischemic heart disease with cavernous artery blood flow in erectile dysfunctional patients. Int J Impot Res. 2001. 13:100–103.

7. Montorsi P, Ravagnani PM, Galli S, Rotatori F, Briganti A, Salonia A, et al. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol. 2005. 96:19M–23M.

8. Stroberg P, Frick E, Hedelin H. Is erectile dysfunction really a clinically useful predictor of cardiovascular disease? Scand J Urol Nephol. 2005. 39:62–65.

9. Song PH, Moon KH, Park TC. Diagnostic utility of 3-dimensional head mounted display in audiovisual sexual stimulation. Korean J Androl. 2004. 22:57–62.

10. Velcek D, Sniderman KW, Vaughan ED Jr, Sos TA, Muecke EC. Penile flow index utilizing a Doppler pulse wave analysis to identify penile vascular insufficiency. J Urol. 1980. 123:669–673.

11. Bacchio M, Scarpelli P, Necozione S, Pelliccione F, Mhialca R, Spartera C, et al. Intima-media thickening of common carotid arteries is a risk factor for severe erectile dysfunction in men with vascular risk factors but no clinical evidence of atherosclerosis. J Urol. 2005. 173:526–529.

12. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): final report. Circulation. 2002. 106:3143–3421.

13. Greenstein A, Chen J, Miller H, Matzkin H, Villa Y, Braf Z. Does severity of ischemic coronary disease correlate with erectile function? Int J Impot Res. 1997. 9:123–126.

14. Solomon H, Man JW, Wierzbicki AS, Jackson G. Relation of erectile dysfunction to angiographic coronary artery disease. Am J Cardiol. 2003. 91:230–231.

15. Burchardt M, Burchardt T, Baer L, Kiss AJ, Pawar RV, Shabsigh A, et al. Hypertension is associated with severe erectile dysfunction. J Urol. 2000. 164:1188–1191.

16. Chew KK, Earle CM, Studkey BG, Jamrozik K, Keogh EJ. Erectile dysfunction in general medicine practice: prevalence and clinical correlates. Int J Impot Res. 2000. 12:41–45.

17. Benet AE, Melman A. The epidemiology of erectile dysfunction. Urol Clin North Am. 1995. 22:699–709.

18. Blumentals WA, Gomez-Caminero A, Joo S, Vannappagari V. Is erectile dysfunction predictive of peripheral vascular disease? Aging Male. 2003. 6:217–221.

19. Feldman HA, McKinlay JB, Goldstein I. Erectile dysfunction, cardiovascular disease and cardiovascular risk factors: prospective results in a large random sample of Massachusetts men. J Urol. 1998. 159:Suppl. 91A. abstract 347.

20. Derby CA, Mohr BA, Goldstein I, Feldman HA, Johannes CB, McKinlay JB. Modifiable risk factors and erectile dysfunction: Can lifestyle changes modify risk? Urology. 2000. 56:302–306.

21. Chung WS, Sohn JH, Park YY. Is obesity an underlying factor in erectile dysfunction? Eur Urol. 1999. 36:68–70.

22. Kim J, Montagnani M, Koh KK, Quon MJ. Reciprocal relationships between insulin resistance and endothelial dysfunction: molecular and pathophysiological mechanisms. Circulation. 2006. 113:1888–1904.

23. Renke M, Edzard S, Jennifer A, Rainer HB. The pathophysiology of erectile dysfunction related to endothelial dysfunction and mediators of vascular function. Vas Med. 2002. 7:213–225.

24. Goligorsky MS, Noiri E, Tsukahara H, Budzikowski AS, Li H. A pivotal role of nitric oxide in endothelial cell dysfunction. Acta Physiol Scand. 2000. 168:33–40.

25. de Groot E, Hovingh GK, Wiegman A, Duriez P, Smit AJ, Fruchart JC, et al. Measurement of arterial wall thickness as a surrogate marker for atherosclerosis. Circulation. 2004. 109:23 Suppl 1. III33–III38.

26. Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997. 96:1432–1437.

27. O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med. 1999. 340:14–22.

28. Veller MG, Fisher CM, Nicolaides AN, Renton S, Geroulakos G, Stafford NJ, et al. Measurement of the ultrasonic intima-media complex thickness in normal subjects. J Vasc Surg. 1993. 17:719–725.

29. Aminbakhsh A, Mancini GB. Carotid intima-media thickness measurements: What defines an abnormality? A systematic review. Clin Invest Med. 1999. 22:149–157.

30. Temelkova-Kurktschiev T, Fisher S, Koehler C, Mennicken G, Henkel E, Hanefeld M. Intima-media thickness in healthy probands without risk factors for arteriosclerosis. Dtsch Med Wochenschr. 2001. 126:193–197.