title: Clinical significance of erectile dysfunction developing after acute coronary event: exception to the rule or confirmation of the artery size hypothesis?
abstract: Erectile dysfunction (ED) has been found to frequently precedes the onset of coronary artery disease (CAD), representing an early marker of subclinical vascular disease, included CAD. Its recognition is, therefore, a "window opportunity" to prevent a coronary event by aggressive treatment of cardiovascular risk factors. The artery size hypothesis (ASH) has been proposed as a putative mechanism to explain the relationship between ED and CAD. Since atherosclerosis is a systemic disorder all major vascular beds should be affected to the same extent. However, symptoms at different points in the system rarely become evident at the same time. This is likely the result of smaller vessels (i.e. the penile artery) being able to less well tolerate the same amount of plaque when compared with larger ones (i.e. the coronary artery). If true, ED will develop before CAD. We present a case in which ED developed after a coronary event yet before a coronary recurrence potentially representing a late marker of vascular progression. Reasons for this unusual sequence are discussed as they might still fit the ASH.
authors.affiliation: Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Montorsi
authors.forename: Paolo M
authors.initials: PM
authors.lastname: Ravagnani
authors.forename: Charalambos
authors.initials: C
authors.lastname: Vlachopoulos
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D001158:Arteries / Q000473:pathology / Q000503:physiopathology; D050197:Atherosclerosis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D018450:Disease Progression; D007172:Erectile Dysfunction / Q000175:diagnosis* / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply; D062645:Percutaneous Coronary Intervention; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists