Copyright © 2004 by the European Society of Cardiology.
Letter to the Editor
Beta-blockers, psychological influences and erectile dysfunction: Reply
Research Unit Department of Medical Sciences, San Raffaele-Roma, Tosinvest Sanità. via della Pisana 235, Rome 00163, Italy
* Corresponding author. Tel.: +39-06-660581; fax: +39-06-9636715
E-mail address: antosilv{at}hotmail.com
The letter of Vacanti et al. highlights the growing interest and importance on the relationship between cardiovascular disease (CVD) and erectile dysfunction (ED). The problem of ED was underestimated before the introduction of PDE5 inhibitors and was rarely investigated in patients with CVD. We agree with Vacanti et al. that distress in patients after an acute myocardial infarction (MI) may be associated with ED. However, we believe that the problem of ED in patients with CVD is more complex and encompasses several different pathogenetic causes. Psychological influence has its importance but the atherosclerotic process and the pharmacological effect of CV drugs have a pivotal role.
It is proven that patients with cardiovascular risk factors for CVD have a significantly higher incidence and severity of ED than patients without risk factors, and that in patients with CVD the incidence and severity of ED is related to the degree of coronary atherosclerosis.1 Since CV risk factors impair endothelial function even when they are subclinical, it is reasonable to believe that the impairment of endothelial function may unmask ED before any clinical manifestation of atherosclerosis. In a vascular bed higly dependent on NO-induced vasodilatation as the penile circulation, the impairment of endothelial function causes ED. As shown by Schachinger et al. in the coronary and peripheral circulation, where other mechanisms of regulation of blood flow are present, angiographically evident atherosclerosis follows by several years the initial impairment of endothelial function.2 Indeed, recent studies have suggested that in patients with a recent MI, ED preceded the clinical manifestation of CVD by several years and that amongst patients with vasculogenic ED,3 otherwise asymptomatic for CVD, there is a high prevalence of coronary atherosclerosis.4 On these grounds, it is plausible that psychological and pharmacological influences may act on a dysfunctional endothelium precipitating ED that is in any case a sign of an impaired endothelial function.
References
- Greenstein A, Chen J, Miller H et al. Does severity of ischemic coronary disease correlate with erectile function? Int. J. Impot. Res. 1997;9(3):123–126.[CrossRef][Web of Science][Medline]
- Schachinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulations. 2000;101(16):1899–1906.
[Abstract/Free Full Text] - Montorsi F, Briganti A, Salonia A et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur. Urol. 2003;44(3):360–365.[CrossRef][Web of Science][Medline]
- Pritzker MR. The penile stress test: a window to the hearts of man. Circulation. 1999;100(18):I-711.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||