Erectile dysfunction predicts generalised cardiovascular disease: Evidence from a case–control study

Aims To determine whether idiopathic erectile dysfunction, in the absence of overt cardiovascular disease or cardiovascular risk factors, is associated with vascular or autonomic dysfunction. Methods We studied 49 men with ED (without known cardiovascular risk factors or disease) and 50 age-matched controls, aged 40–70 years. Macrovascular endothelial function was examined by brachial artery ultrasonography and microvascular function by venous occlusion plethysmography. Blood pressure measurement and electrocardiography were performed lying and standing, and the 30:15 RR ratio calculated. Results Body mass index, testosterone, fasting lipids and glucose did not differ significantly between groups. Standing pulse pressure was higher (50 ± 1 mm Hg versus 43 ± 2 mm Hg, p < 0.004) and 30:15 RR ratio lower (0.97 ± 0.01 versus 1.01 ± 0.01, p < 0.02) in the ED group. Flow-mediated dilatation of the brachial artery was not significantly different between groups. Flow debt repayment during forearm reactive hyperaemia was lower in the ED group (7.2 ± 0.7 ml versus 9.5 ± 0.8 ml per 100 ml, p < 0.02) than in controls. Conclusions Men with idiopathic ED have evidence of endothelial dysfunction in forearm resistance vessels, increased pulse pressure and impaired heart rate variability. This supports the concept that erectile dysfunction is a predictor of cardiovascular dysfunction and a precursor of clinical cardiovascular disease.