title: Efficacy and limits of sildenafil citrate in patients with arterial erectile dysfunction: role of peripheral arterial disease and cardiovascular comorbidities.
abstract: OBJECTIVE
  To evaluate whether the response to sildenafil administration in patients with arterial erectile dysfunction (ED) was related to their peak systolic velocity (PSV), peripheral atherosclerosis, cardiovascular risk factors (RF) and/or comorbidities at low cardiovascular risk.
  
  
  METHODS
  We enrolled 97 patients with 1-2 RF and comorbidities, combined with arterial ED alone (group A, n = 27), ED plus atherosclerotic carotid artery (group B, n = 23), ED plus lower limb artery abnormalities (group C, n = 25), and ED plus carotid and lower limb artery abnormalities (group D, n = 22). Sildenafil efficacy (100 mg twice a week for 12 weeks) was also examined in patients with =or>3 RF, peripheral atherosclerosis and no cardiovascular comorbidities (group E, n = 20).
  
  
  RESULTS
  Median PSV was 24.1, 21.0, 19.3, 14.5 and 17.5 cm/s in groups A, B, C, D and E, respectively. Sildenafil response was higher in group A patients (77.8%), intermediate in groups B and C (65.2% and 56%) and lowest in groups D (45.4%) and E (50%), and the response in latter two groups was significantly lower than in the other three groups. In addition, sildenafil response was negatively influenced by: =or>3 RF, peripheral atherosclerosis and no systemic comorbidity, or presence of 1-2 RF associated with extended atherosclerosis and comorbidities. The number of comorbidities was positively related to atherosclerosis localization or extension (25, 35, 38 and 47 in groups A, B, C and D, respectively).
  
  
  CONCLUSIONS
  Low sildenafil efficacy in patients with arterial ED was associated with extended atherosclerosis. These patients should undergo extensive ultrasonography and a full cardiovascular examination.
authors.affiliation: Department of Biomedical Sciences, University of Catania, Catania 95123, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Vicari
authors.forename: Mariano
authors.initials: M
authors.lastname: Malaguarnera
authors.forename: Sandro
authors.initials: S
authors.lastname: La Vignera
authors.forename: Fabio
authors.initials: F
authors.lastname: Calzavara
authors.forename: Carmelo
authors.initials: C
authors.lastname: Battiato
authors.forename: Aldo E
authors.initials: AE
authors.lastname: Calogero
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D050197:Atherosclerosis / Q000150:complications; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy*; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D010879:Piperazines / Q000627:therapeutic use*; D011687:Purines / Q000627:therapeutic use; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate