Many people are
hesitant to consult for erectile dysfunction(ED) in their mid 50 s.They think
it is a part of ageing.But erectile dysfunction in middle ages can be because
of generalised endothelial dysfunction.It could be a presursor of future heart
problems.That is the reason many andrologist would call erectile dysfunction as
a “wake up call” to coronary artery
disease.It has been found that after
adjustment for age, ED correlated with the presence of heart disease,
hypertension, Diabetes Mellitus, smoking and inversely with protective
Lipids(HDL).
Penile erection is caused by a
series of actions: relaxation of cavernosal arteries and cavernosal sinuses
leads to increased blood flow into the penis, pooling of blood in the sinuses,
and an increase in corpus cavernosum pressure.The same NO-cGMP pathway that is
critical to erectile function was discovered years earlier as a key endothelium
derived dilator of arteries in the systemic, coronary, and
pulmonary vasculatures.In the
clinical setting, loss of endothelial NO occurs in the earliest stages of
atherosclerosis. In fact, it has been linked to each of the known atherogenic
risk factors, such as various forms of dyslipidemia, hypertension, diabetes,
cigarette smoking, aging, menopause, hyperhomocystinemia, and a family history
of premature atherosclerosis.Although atherosclerosis
in its early stages tends to be focal,
preferentially localizing to sites of
abnormal hemodynamic stresses, loss of endothelium-derived NO in the setting of risk factors is
much more generalized and affects nearly all
arterial beds, including the arterial
blood supply to the penis and the endothelium lining cavernosal sinuses.
Because
the arteries supplying penis are smaller than the coronary arteries.So the
process causing decereased flow in penile arteries is an harbinger of decreased
flow in heart and brain vessels in the future.
So,
57% of men undergoing coronary artery bypass grafting and 64% of men with acute
myocardial infarction had preceding ED of some duration. Interestingly,
subjects with ED have evidence of endothelial dysfunction in systemic arteries,
and an impairment in the NO-cGMP pathway is present before any other evidence
of atherosclerotic process is detectable by sophisticated testing. It has been
suggested that a deficiency of NO manifests early as ED because erection
requires a comparatively large, perhaps 80%, dilation of penile arteries, and
hence, this system can ill-afford a loss of NO.Thus, ED, just as endothelial
dysfunction, appears to be a sensitive forerunner of atherosclerosis and its
complications.
Thanks for sharing the information about the Penile stress test:window to hearts of men Don’t Ignore Erectile Dysfunction.
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