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Peng H, Zhang H, Xin S, Li H, Liu X, Wang T, Liu J, Zhang Y, Song W. Associations between Erectile Dysfunction and Vascular Parameters: A Systematic Review and Meta-Analysis. World J Mens Health 2024; 42:712-726. [PMID: 38311372 PMCID: PMC11439810 DOI: 10.5534/wjmh.230192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/13/2023] [Accepted: 10/03/2023] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Erectile dysfunction (ED) is associated with several vascular disorders, but the associations between ED and vascular parameters are still unclear. MATERIALS AND METHODS We analyzed and synthesized a comprehensive range of studies from PubMed, Web of Science, and Scopus regarding the associations between ED and the following measures: ankle-brachial index (ABI), pulse wave velocity (PWV), intima-media thickness (IMT), nitrate-mediated dilation (NMD), flow-mediated dilation (FMD), augmentation index (AI), endothelial progenitor cells (EPCs) and other vascular parameters. Subgroup analysis was conducted according to specific types of parameters. Study quality was assessed by using the Newcastle-Ottawa Scale. Sensitivity analysis was conducted to confirm the robustness of the pooled results. RESULTS Fifty-seven studies with 7,312 individuals were included. Twenty-eight studies were considered to be high-quality. ED patients had a 0.11 mm higher IMT (95% confidence interval [CI]: 0.07, 0.15), a 2.86% lower FMD (95% CI: -3.56, -2.17), a 2.34% lower NMD (95% CI: -3.37, -1.31), a 2.83% higher AI (95% CI: 0.02, 5.63), a 1.11 m/s higher PWV (95% CI: 0.01, 2.21), and a 0.72% lower percentage of EPCs (95% CI: -1.19, -0.24) compared to those without ED. However, ABI was similar between ED patients and non-ED individuals. According to sensitivity analysis, the pooled results were robust. CONCLUSIONS Our study confirmed the associations between ED and several vascular parameters and highlighted the importance of prevention and management of vascular and endothelial dysfunction in ED patients.
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Affiliation(s)
- Hao Peng
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The Second Clinical School, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hanlin Zhang
- The First Clinical School, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Xin
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Wen Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Bulbul E, Ozilhan MO, Sezer A, Yetisen M, Ilki FY. Possible Clinical Benefits of Cardio-Ankle Vascular Index Measurement in Urological Diseases. Vasc Health Risk Manag 2023; 19:127-132. [PMID: 36923496 PMCID: PMC10010130 DOI: 10.2147/vhrm.s384937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Many factors are considered to affect vascular physiology. It is known that one of the reasons for many diseases is a pathology at the microvascular level. Therefore, the relationship between endothelial dysfunction and many diseases is currently being investigated. The clinical evaluations of arterial stiffness have made it possible to perform necessary risk assessment regarding cardiovascular diseases. In this way, protective measures can be taken against microvascular pathologies in many organs. In this paper, we present a review of studies investigating the relationship between urological conditions and the cardio-ankle vascular index (CAVI), a marker of arterial stiffness. As with erectile dysfunction, some studies have shown that conditions such as lower urinary tract symptoms, overactive bladder, and chronic kidney disease are also associated with an elevated CAVI. The association of erectile dysfunction and chronic kidney disease with vascular pathologies has been clearly demonstrated. In addition, lower urinary tract symptoms may be the first sign of silent vascular dysfunction. Assessing arterial stiffness with CAVI can help prevent future cardiovascular events in these patients.
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Affiliation(s)
- Emre Bulbul
- Department of Urology, Trabzon Vakfıkebir State Hospital, Trabzon, Turkey
| | | | - Ali Sezer
- Department of Urology, Konya City Hospital, Konya, Turkey
| | - Mustafa Yetisen
- Department of Cardiology, Erzurum Oltu State Hospital, Erzurum, Turkey
| | - Fahri Yavuz Ilki
- Department of Urology, Gulhane Training and Research Hospital, Ankara, Turkey
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Fukumoto K, Nagai A, Hara R, Fujii T, Miyaji Y. Tadalafil for male lower urinary tract symptoms improves endothelial function. Int J Urol 2016; 24:206-210. [DOI: 10.1111/iju.13273] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Kazuhiko Fukumoto
- Department of Urology; Kawasaki Medical School; Kurashiki Okayama, Japan
| | - Atsushi Nagai
- Department of Urology; Kawasaki Medical School; Kurashiki Okayama, Japan
| | - Ryoei Hara
- Department of Urology; Kawasaki Medical School; Kurashiki Okayama, Japan
| | - Tomohiro Fujii
- Department of Urology; Kawasaki Medical School; Kurashiki Okayama, Japan
| | - Yoshiyuki Miyaji
- Department of Urology; Kawasaki Medical School; Kurashiki Okayama, Japan
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Özdabakoğlu O, Güllülü S, Sağ S, Şentürk T, Kiliçarslan H, Tütüncü A, Keçebaş M, Baran I, Aydinlar A. Evaluation of arterial stiffness and cardiac function in patients with vascular erectile dysfunction: acute effects of phosphodiesterase-5 inhibitor tadalafil. Int J Impot Res 2016; 29:96-100. [PMID: 27928151 DOI: 10.1038/ijir.2016.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 07/15/2016] [Accepted: 10/03/2016] [Indexed: 11/09/2022]
Abstract
This study aimed to detect endothelial dysfunction in erectile dysfunction (ED) patients free from cardiovascular diseases or atherosclerotic risk factors and to evaluate acute effects of phosphodiesterase-5 inhibitor tadalafil on endothelial dysfunction and cardiac function. Thirty ED patients and 20 healthy male subjects (mean ages: 48.7±11.7 and 48.3±8.7 years, respectively) were enrolled. Endothelium functions were assessed by applanation tonometry. Aortic stiffness and cardiac function were evaluated by transthoracic echocardiography. Pulse pressure was greater in the ED group (P<0.05), whereas aortic strain and aortic distensibility were significantly lower (P<0.001). Treatment with tadalafil reduced pulse pressure (P=0.0179), systolic blood pressure (P=0.001) and diastolic blood pressure (P=0.054) and increased aortic distensibility (P=0.001) and aortic strain (P=0.003) in the ED group. Tadalafil administration also increased large artery and small artery elasticity indices that were reduced in the ED group at baseline (P=0.02 and 0.003, respectively). Systemic vascular disease and compromised left ventricular diastolic function (LVDF) were present in ED patients with no known atherosclerotic risk factors and cardiac diseases. Tadalafil positively affected arterial stiffness and LVDF.
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Affiliation(s)
- O Özdabakoğlu
- Department of Cardiology, Uludag University, Bursa, Turkey
| | - S Güllülü
- Department of Cardiology, Uludag University, Bursa, Turkey
| | - S Sağ
- Department of Cardiology, Uludag University, Bursa, Turkey
| | - T Şentürk
- Department of Cardiology, Uludag University, Bursa, Turkey
| | - H Kiliçarslan
- Department of Urology, Uludag University, Bursa, Turkey
| | - A Tütüncü
- Department of Cardiology, Uludag University, Bursa, Turkey
| | - M Keçebaş
- Department of Cardiology, Uludag University, Bursa, Turkey
| | - I Baran
- Department of Cardiology, Uludag University, Bursa, Turkey
| | - A Aydinlar
- Department of Cardiology, Uludag University, Bursa, Turkey
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Schwartz BG, Jackson G, Stecher VJ, Campoli-Richards DM, Kloner RA. Phosphodiesterase type 5 inhibitors improve endothelial function and may benefit cardiovascular conditions. Am J Med 2013; 126:192-9. [PMID: 23410557 DOI: 10.1016/j.amjmed.2012.08.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 08/29/2012] [Accepted: 08/29/2012] [Indexed: 11/19/2022]
Abstract
The effects of phosphodiesterase type 5 inhibitors on vasodilation mediated via nitric oxide-cyclic guanosine monophosphate are well described. Less is known about other mechanisms through which phosphodiesterase type 5 inhibitors benefit endothelial function, including normalization of serum biomarkers, increased levels of endothelial progenitor cells, ischemia-reperfusion protection mechanisms, and other actions specific to patients with diabetes. These various mechanisms are reviewed. Their impact on several cardiovascular diseases, including erectile dysfunction, pulmonary hypertension, heart failure, high-altitude pulmonary edema, Raynaud's phenomenon, coronary artery disease, diabetes, and atherosclerosis, is presented.
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Affiliation(s)
- Bryan G Schwartz
- Heart Institute, Good Samaritan Hospital, Los Angeles, Calif 90017-2395, USA
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Guazzi M, Arena R, Pinkstaff S, Guazzi MD. Six months of Sildenafil therapy improves heart rate recovery in patients with heart failure. Int J Cardiol 2008; 136:341-3. [PMID: 18667251 DOI: 10.1016/j.ijcard.2008.04.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 04/26/2008] [Indexed: 11/19/2022]
Abstract
Previous research has demonstrated an increase in large vessel stiffness in patients with heart failure (HF). Furthermore, heart rate recovery (HRR) may be negatively impacted by increased arterial stiffness secondary to altered baroreceptor discharge. The purpose of the present study was to determine if chronic phosphodiesterase 5 (PDE5) inhibition with Sildenafil, previously shown to improve arterial stiffness, favorably impacts HRR in patients with HF. Forty male subjects (age: 65.3+/-7.3 years, baseline ejection fraction: 37.1+/-7.4%, 15 non-ischemic HF/25 ischemic HF) participated in this study. Subjects received Sildenafil (25 mg, 3 times/day) for six months. Symptom-limited exercise testing was performed at baseline and six months with a lower extremity ergometer. Heart rate recovery was defined as HR at maximal exercise minus HR at 1 min recovery. No adverse effects were reported throughout the study period. Paired t-testing revealed that HRR was significantly improved following six months of Sildenafil therapy (baseline: 17.5+/-3.5 bpm vs. Post: 20.6+/-3.2 bpm). The results of the present study indicate that chronic Sildenafil therapy significantly increases HRR, an important prognostic marker, in patients with HF. A plausible mechanism for the improvement of HRR is the previously demonstrated impact Sildenafil has on arterial stiffness and therefore baroreceptor function.
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Affiliation(s)
- Marco Guazzi
- University of Milano, San Paolo Hospital, Cardiopulmonary Laboratory, Cardiology Division, University of Milano, San Paolo Hospital, Milano, Italy
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