P499Subclinical vascular disease in patients with erectile dysfunction: correlation with high sensitivity C-reactive protein levels


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Abstract

Background:Erectile dysfunction(ED) may be early clinical manifestation of a generalized vascular disease & carries an independent risk for cardiovascular(CVS) events. Low-grade subclinical inflammation affects endothelial function & involved in all stages atherosclerotic process.Objectives:To test hypothesis that,erectile dysfunction in men without CVS disease or its major risk factors may be earliest sign of generalized vascular dysfunction & correlate this with high sensitivity C-reactive protein(hs-CRP) levels.Patients&Methods: The study enrolled 115 men with ED without CVS disease or its major risk factors & 40 age matched healthy men as a control group.For all participants, assessment of LV function,aortic strain(AS),distensibility(AD)& aortic wall systolic velocity(AWSV) was done using conventional echocardiography & Doppler tissue imaging. B-mode ultrasonic examination of common carotid & brachial arteries was performed for measurement of carotid intima-media thickness(CIMT),brachial artery flow-mediated (FMD)& nitroglycerine-mediated vasodilatation (NTGMD). Ultrasensitive immunoassay used to measure serum hs-CRP.Results: CIMT& hs-CRP were significantly higher in patients than controls (0.82±0.22 mm vs.0.53±0.31 mm & 6.72±1.5 mg/L vs.2.1±.78 mg/L respectively,p< 0.001 for all),whereas AWSV,AS & AD were significantly lower in patients compared to control group(6.1±2.1 cm/sec vs.9.1±1.6 cm/sec, 10.6±6% vs. 17.9±7 %,& 7±3 cm2/dyn/103 vs.12±5 cm2/dyn/103 respectively,p< 0.001 for all). ΔFMD & FMD% that reflect endothelial function status were significantly impaired in patients compared to controls(0.67±0.33 mm vs. 2.1±0.29 mm &21% vs. 50% respectively,P<0.001 for each); while ΔNTGMD & NTGMD% did not differ significantly between two groups (2.1± 0.73 mm vs. 2.3± 0.59 mm & 49% vs.51% respectively,P>0.05 for each). A strong positive correlation found between ED severity & CIMT( r =.55), hs-CRP( r =.6) while correlation was negative between ED & AWSV ( r = - .83), AS( r - =.63),AD( r = - .65) ),FMD( r = -.85), p< 0.001 for all.Conclusion: Aortic, carotid & brachial artery functional parameters are all impaired in addition to elevated hs-CRP levels in patients with ED without CVS disease or its major risk factors, suggesting that, ED would represent an early clinical manifestation of a diffuse systemic subclinical vascular disease. It is, therefore, crucial to identify asymptomatic patients with ED who may be at risk of occult CVS diseases. Their early recognition may lead to treatment of risk factors & conditions associated with endothelial dysfunction, hopefully reducing the rate of major CVS events.

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