Link Between Vasculogenic ED, CAD, and PAD

Abstract and Introduction

Abstract

Erectile dysfunction (ED) is estimated to affect 150 million people worldwide and may indicate diffuse systemic macrovascular disease. Endothelial dysfunction represents the probable pathophysiological link between vasculogenic ED, coronary artery disease (CAD), and peripheral artery disease (PAD), and the artery size hypothesis along with evidence-based research support ED as the incident clinical event. Given that many common risk factors for atherosclerosis, including smoking, diabetes mellitus, hyperlipidemia, and obesity are prevalent and causative in patients with ED, it is likely that metabolic factors play a crucial role in the link between the two disorders. The interplay of these factors provides a unifying physiological, endocrinological, and behavioral model for the association between ED, CAD, and PAD. Current therapy is unlikely to reverse the natural history of ED. Percutaneous revascularization may improve ED symptoms, and thereby quality of life, in a select group of patients. Large prospective studies are needed to define male pelvic arterial anatomy and thus enhance the utilization of internal pudendal angiography and revascularization. In this review, we provide an overview of normal erectile anatomy and physiology, the pathophysiology of ED, currently accepted diagnostic imaging modalities and treatments for ED, and recently investigated endovascular therapies for ED.

Introduction

Erectile dysfunction (ED) is defined as the recurrent or persistent inability to achieve or maintain an erection in order for satisfactory intercourse to occur. Age-related decline in erectile function was first documented by Kinsey et al in 1948, though ED was thought primarily a psychogenic disorder until the late 20th century.^[1] Only recently has ED been recognized as an organic and physiologic abnormality affecting the penile circulation as part of a more generalized vascular disorder. The contemporary prevalence of ED is approximately 52% in the general population between 40 and 70 years of age; both the prevalence and the severity of ED increase with age.^[2] It is estimated that ED affects 150 million people worldwide and this number is expected to more than double by the year 2025.^[3] In many patients, ED may be the first manifestation of a single clinical disease spectrum that will progress to include coronary artery disease (CAD) and peripheral artery disease (PAD) at a later stage. Indeed, in men with CAD, the prevalence of ED is as high as 75%.^[4,5] In this review, we provide an overview of normal erectile anatomy and physiology, the pathophysiology of ED, currently accepted diagnostic imaging modalities and treatments for ED, and recently investigated endovascular therapies for ED.