Inflammation, metabolic syndrome, erectile dysfunction, and coronary artery disease: common links.
OBJECTIVE
Erectile dysfunction (ED) may be the early clinical manifestation of a generalized vascular disease and carries an independent risk for cardiovascular events. Low-grade subclinical inflammation affects endothelial function and is involved in all stages of the atherosclerotic process. This review identifies potential pathophysiologic links among low-grade inflammation, ED, metabolic syndrome, and coronary artery disease (CAD) and presents the clinical implications in terms of ED diagnosis, assessment of patient risk, and therapy.


METHODS
A comprehensive evaluation was performed for available published data in full-length papers that were identified in MedLine up to July 2007.


RESULTS
Studies support an association between metabolic syndrome, ED, and increased inflammatory state. Increased circulating levels of inflammatory and endothelial-prothrombotic compounds are related to the presence and severity of ED. Specific inflammatory biomarkers and their combination appear to have the potential to aid ED diagnosis or exclusion. ED and CAD may confer a similar unfavorable impact on the inflammatory and prothrombotic state, whereas ED adds an incremental activation on top of CAD; these findings have important implications for cardiovascular risk. Lifestyle and risk factor modification, as well as pharmacologic therapy, are associated with anti-inflammatory effects.


CONCLUSIONS
Low-grade systemic inflammation could be an important element of the association between metabolic syndrome, ED, and CAD. Its individualized assessment may be a valuable tool for ED diagnosis, risk assessment, and rationalized therapeutic approach especially in patients with ED who have metabolic syndrome and carry an intermediate risk for future cardiovascular events.
Vlachopoulos
Charalambos
C
Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece. cvlachop@otenet.gr
Rokkas
Konstantinos
K
Ioakeimidis
Nikolaos
N
Stefanadis
Christodoulos
C
D050197:Atherosclerosis / Q000209:etiology; D003324:Coronary Artery Disease / Q000209:etiology*; D004730:Endothelium, Vascular / Q000502:physiology; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D011379:Prognosis