title: Microvascular endothelial dysfunction predicts the development of erectile dysfunction in men with coronary atherosclerosis without critical stenoses.
abstract: BACKGROUND
  Erectile dysfunction (ED) is associated with an increased risk for cardiovascular disease, stroke, and all-cause mortality, independent of conventional cardiovascular risk factors. Coronary endothelial dysfunction is independently associated with ED in men with early coronary atherosclerosis. We aimed to investigate whether coronary microvascular dysfunction predicts development of ED in patients presenting with coronary atherosclerosis without critical stenoses.
  
  
  METHODS
  Coronary microvascular function was evaluated in 130 men with coronary atherosclerosis without critical stenoses by administration of intracoronary acetylcholine at the time of diagnostic study. After a mean follow-up of 8.4 years, patients were assessed for the development of ED by administration of a questionnaire.
  
  
  RESULTS
  In all, 68 (50%) men had microvascular endothelial dysfunction at baseline; 35 (51%) men with microvascular endothelial dysfunction developed ED on follow-up compared with 19 (31%) men without microvascular endothelial dysfunction. Men who developed ED had a lower coronary blood flow response (% [INCREMENT]CBF) compared with men who did not develop ED, with mean±SD of 25.4±71.3 versus 81.7±120 (P=0.003). In univariate analysis, microvascular endothelial dysfunction was a predictor for the development of ED, with relative risk of 2.4 (1.2-4.9) (P=0.016). In multivariate logistic regression adjusting for traditional cardiovascular risk factors (age, hypertension, hyperlipidemia, diabetes, vascular disease, and family history of coronary artery disease), only microvascular endothelial dysfunction (P=0.027) and age (P=0.044) remained significant predictors of development of ED.
  
  
  CONCLUSIONS
  Coronary microvascular dysfunction is a predictor of the development of ED in men with coronary atherosclerosis without critical stenoses. This study underscores the systemic involvement of the endothelial function in vascular disease.
authors.affiliation: aDivision of Cardiovascular Diseases bDivision of Nephrology and Hypertension cUnit of Biomedical Statistics and Informatics, Mayo Clinic and College of Medicine, Rochester, Minnesota, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Reriani
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Flammer
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Megha
authors.initials: M
authors.lastname: Prasad
authors.forename: Charanjit
authors.initials: C
authors.lastname: Rihal
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.forename: Ryan
authors.initials: R
authors.lastname: Lennon
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000109:Acetylcholine; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000503:physiopathology*; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D055806:Microvessels / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014664:Vasodilation / Q000502:physiology; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D000109:Acetylcholine