title: Small-vessel lower extremity arterial disease and erectile dysfunction: The Rancho Bernardo study.
abstract: OBJECTIVE
  Although erectile dysfunction (ED) has been associated with heart disease risk factors and large-vessel lower extremity arterial disease (LEAD), no community-based studies have reported the association between ED and small-vessel LEAD, despite the similar size of the arteries affected. We examined whether small-vessel LEAD is associated with ED, and whether this association is independent of cardiovascular risk factors and medications.
  
  
  RESULTS
  Community-dwelling men, average age 71, completed the International Index of Erectile Function-5 questionnaire and had measurements recorded of toe-brachial index (TBI), a measure of small-vessel LEAD. TBI, 12 cardiovascular risk factors, and medications were used as categorical predictors in age-adjusted bivariate analyses, and as continuous covariates in multivariable linear regression analyses, to determine their independent association with severity of ED. In the age-adjusted categorical model, the level of TBI (low, medium, high) was associated with the severity of ED (beta=0.364; 95% CI: 0.102, 0.625). In the final multivariable linear regression model, which controlled for age and systolic blood pressure, lower TBI (i.e., more severe small-vessel LEAD) was significantly and independently associated with more severe ED (beta=0.422; 95% CI: 0.019, 0.826).
  
  
  CONCLUSIONS
  The severity of small-vessel LEAD is significantly and independently associated with the severity of ED. The mechanism for this association remains to be determined, but these data are compatible with the hypothesis that concurrent ED and small-vessel LEAD signify a diffuse microvascular process involving multiple small-vessel arterial beds.
authors.affiliation: Department of Internal Medicine, University of California, San Diego Medical Center, United States.
authors.forename: Shua J
authors.initials: SJ
authors.lastname: Chai
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: Anthony
authors.initials: A
authors.lastname: Gamst
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001808:Blood Vessels / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000473:pathology; D007172:Erectile Dysfunction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D035002:Lower Extremity / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors
references.citation: Int J Impot Res. 1999 Dec;11(6):319-26
references.pmid: 10637462
references.citation: J Clin Hypertens (Greenwich). 2006 Nov;8(11):768-74
references.pmid: 17086016
references.citation: Urology. 2000 Sep 1;56(3):477-81
references.pmid: 10962319
references.citation: J Urol. 2000 Oct;164(4):1188-91
references.pmid: 10992363
references.citation: J Am Geriatr Soc. 2001 Apr;49(4):436-42
references.pmid: 11347788
references.citation: J Urol. 2001 Aug;166(2):569-74; discussion 574-5
references.pmid: 11458070
references.citation: Ann Intern Med. 2003 Aug 5;139(3):161-8
references.pmid: 12899583
references.citation: Eur Urol. 2003 Sep;44(3):360-4; discussion 364-5
references.pmid: 12932937
references.citation: BJU Int. 2003 Dec;92(9):977-80
references.pmid: 14632859
references.citation: J Am Coll Cardiol. 2004 Jan 21;43(2):179-84
references.pmid: 14736434
references.citation: Aging Male. 2003 Dec;6(4):217-21
references.pmid: 15006259
references.citation: J Am Coll Cardiol. 2004 Apr 21;43(8):1405-11
references.pmid: 15093875
references.citation: Diabetes Care. 2004 Jun;27(6):1381-6
references.pmid: 15161792
references.citation: JAMA. 2004 Jun 23;291(24):2978-84
references.pmid: 15213209
references.citation: J Cardiovasc Surg (Torino). 1983 Jan-Feb;24(1):43-8
references.pmid: 6833352
references.citation: Am J Epidemiol. 1989 Jun;129(6):1110-9
references.pmid: 2786328
references.citation: JAMA. 1993 Jul 28;270(4):487-9
references.pmid: 8147959
references.citation: Circulation. 1993 Aug;88(2):819-28
references.pmid: 8339448
references.citation: Circulation. 1993 Sep;88(3):837-45
references.pmid: 8353913
references.citation: Urology. 1997 Jun;49(6):822-30
references.pmid: 9187685
references.citation: Int J Impot Res. 2005 May-Jun;17(3):277-82
references.pmid: 15744330
references.citation: Clin Physiol Funct Imaging. 2005 May;25(3):129-34
references.pmid: 15888091
references.citation: Am J Cardiol. 2005 Dec 26;96(12B):19M-23M
references.pmid: 16387561
references.citation: Int J Impot Res. 2006 Mar-Apr;18(2):175-9
references.pmid: 16163371
references.citation: Circulation. 2006 Jun 6;113(22):2623-9
references.pmid: 16735675
references.citation: Arch Med Res. 2006 Nov;37(8):1004-9
references.pmid: 17045118
references.citation: N Engl J Med. 2000 Jun 15;342(24):1802-13
references.pmid: 10853004