Dynamic penile peak systolic velocity predicts major adverse cardiovascular events in hypertensive patients with erectile dysfunction.

OBJECTIVE: Hypertension is associated with an abnormal penile blood flow. Reduced dynamic penile peak systolic velocity (D-PSV) correlates with adverse cardiovascular outcomes. The aim of this study is to investigate whether abnormal penile blood flow predicts major adverse cardiovascular events (MACE) in hypertensive men. METHODS: In total, 298 hypertensive men (55 ±â€Š9 y/o) without known cardiovascular disease or diabetes were evaluated for cavernous vascular disease severity by dynamic penile Doppler ultrasound. The whole population was divided into tertiles according to D-PSV reduction (low tertile <25 cm/s; middle tertile 25-35 cm/s; and high tertile >35 cm/s). Predictive performance was evaluated with calibration, discrimination, and reclassification. RESULTS: During the mean follow-up period of 4.9 years, a total of 22 (7%) MACE occurred. D-PSV level was associated with MACE and the differences between the tertiles were significant (Mantel log-rank test: 6.54; P < 0.01). A Cox proportional hazard model showed that study participants in the lowest D-PSV tertile (<25 cm/s) had an approximately 3.5-fold higher MACE risk compared with those in the highest D-PSV tertile (>35 cm/s) after adjustment for age, systolic pressure, metabolic parameters, smoking, C-reactive protein, and testosterone levels. Low D-PSV did not significantly improve the C-statistic model (0.774 vs. 0.767; P = 0.44), whereas the calibration was satisfactory (Hosmer-Lemeshow X = 8.73, P = 0.30). When only intermediate-risk patients were evaluated, the risk reclassification beyond traditional risk factors resulted in a clinical net reclassification index of 9.2% that was marginally significant (P = 0.07). The integrated discrimination improvement index showed better performance of the model that included D-PSV compared with the reference model in identifying MACE (improvement index: 0.047, P = 0.038). CONCLUSION: Low-penile blood flow predicts MACE in hypertensive patients free of clinical atherosclerosis. This predictive ability is independent of the severity of hypertension and decreased testosterone that is often present in such patients.

Amino-terminal pro-C-type natriuretic peptide is associated with the presence, severity, and duration of vasculogenic erectile dysfunction.

BACKGROUND: Endothelial dysfunction is a key event in the pathophysiology of erectile dysfunction (ED) and generalized vascular disease. C-type natriuretic peptide (CNP) is a paracrine molecule that effects endothelial integrity and vascular tone. OBJECTIVE: To determine the role of CNP in men with vasculogenic ED. DESIGN, SETTING, AND PARTICIPANTS: Fifty-two consecutive men (age: 57+/-10 yr) with nonpsychogenic and nonhormonal ED for >6 mo and free of cardiovascular disease who were referred to the Cardiovascular Diseases and Sexual Health Unit of our Department for evaluation of ED were compared with 31 subjects with normal erectile function matched for age, body mass index, and traditional risk factors. MEASUREMENTS: Vasculogenic ED was diagnosed according to comprehensive history, physical examination, Sexual Health Inventory for Men (SHIM-5) scoring, hormonal testing, and penile color-Doppler ultrasound. Amino-terminal proCNP (NT-proCNP) was measured in plasma with enzyme-linked immunosorbent assay (ELISA). RESULTS AND LIMITATIONS: Compared to controls, ED patients had significantly lower NT-proCNP levels (0.21+/-0.08 pmol/l in ED patients vs 0.34+/-0.07 pmol/l in control subjects; p<0.001). NT-proCNP levels were associated with erectile performance as expressed by SHIM-5 score (r=0.57; p<0.001), even after adjusting for confounders. There was also an inverse linear relationship between ED duration and NT-proCNP levels (p<0.05). In patients with arteriogenic ED, there was a positive correlation of NT-proCNP levels with peak systolic velocity (PSV) (r=0.51; p=0.01). CONCLUSIONS: CNP levels are associated with the presence, severity, and duration of ED. These findings provide further insight into the role of CNP in the pathophysiology of ED.

Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study.

OBJECTIVES: Erectile dysfunction (ED) shares common risk factors with coronary artery disease (CAD). It has been suggested that ED may be considered a clinical manifestation of a generalized vascular disease affecting also the penile arteries. The aim of this prospective study was to evaluate angiographically the incidence of asymptomatic CAD in men with ED of vascular origin. METHODS: Fifty consecutive asymptomatic men, aged 41-74 years, with non-psychogenic and non-hormonal ED were comprehensively evaluated using medical history and examination, exercise treadmill test and stress echocardiography. Patients who had positive one or both of the two non-invasive procedures were referred for coronary arteriography in order to document CAD and evaluate the severity of the disease. RESULTS: The mean time interval between the onset of ED and cardiological assessment was 25 months (range 1-66). Smoking (32 patients/64%), hypertension (31 patients/62%) and hyperlipidemia (26 patients/52%) were the most common risk factors. Moreover, 35 men (70%) had two or more risk factors. Twelve patients (24%) with ED had positive one or both of the two non-invasive procedures and one patient presented with acute myocardial infarction before he completed the non-invasive investigation. Coronary arteriography performed in ten patients (in nine with positive one or both of the two non-invasive procedures [while the other three refused], and in the patient with acute myocardial infarction) demonstrated that one patient had three-vessel disease, two patients had two-vessel disease and six patients had single-vessel disease. CONCLUSIONS: A considerable proportion (9/47 or 19%) of patients with ED of vascular origin has angiographically documented silent CAD. These findings support the strategy that patients with ED should undergo further cardiovascular evaluation.