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European Heart Journal Advance Access published online on October 20, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl341
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received April 16, 2006
Revised October 3, 2006
Accepted October 5, 2006

Clinical research

Unfavourable endothelial and inflammatory state in erectile dysfunction patients with or without coronary artery disease

Charalambos Vlachopoulos 1 *, Konstantinos Aznaouridis 1, Nikolaos Ioakeimidis 1, Konstantinos Rokkas 1, Carmen Vasiliadou 1, Nikolaos Alexopoulos 1, Elli Stefanadi 1, Athanasios Askitis 1, and Christodoulos Stefanadis 1

1 Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Kerassoundos 17, Athens 11528, Greece

* To whom correspondence should be addressed.
Charalambos Vlachopoulos, E-mail: cvlachop{at}otenet.gr


  Abstract

Aims Erectile dysfunction (ED) confers an independent cardiovascular risk. We investigated the role of low-grade inflammation and endothelial dysfunction in ED patients with or without coronary artery disease (CAD).

Methods and results We evaluated 141 men (age 58.8 years) for ED and CAD through a rigourous investigation (including coronary angiography to reveal occult CAD). Blood levels of inflammatory (hsCRP, IL-6, IL-1{beta}, and TNF-{alpha}) and endothelial-prothrombotic markers/mediators (vWF, tPA, PAI-1, and fibrinogen) were significantly increased in ED patients and correlated negatively with sexual performance. ED was associated with higher levels of these substances (except for IL-6) on top of CAD alone. For most substances, the unfavourable impact of ED alone was not significantly different than the impact of CAD alone. In multivariable models, these markers/mediators predicted independently ED presence. In our population, the negative predictive value of the combination of fibrinogen <225 mg/dL with IL-6 < 1.24 pg/mL for excluding ED was 91.7% (95% CI: 61.5 - 99.8).

Conclusion ED is associated with increased inflammatory and endothelial-prothrombotic activation in men with or without CAD. ED confers an incremental unfavourable impact on the circulating levels of these markers/mediators when combined with CAD. These findings have implications for increased cardiovascular risk in ED patients.

Keywords: Coagulation; Coronary artery disease; Endothelial dysfunction; Erectile dysfunction; Inflammation.
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