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La dysfonction érectile, un marqueur précoce d’atteinte cardio-vasculaire

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La dysfonction érectile (DE) atteint approximativement 100 millions d’hommes dans le monde et touche 50% des hommes âgés de 40 à 70 ans. L’atteinte vasculaire des artères péniennes en est la cause la plus commune, mais la DE, pourrait être aussi un signe révélateur de maladie cardiovasculaire (MCV).

Les arguments principaux en faveur de cette affirmation sont essentiellement épidémiologiques mais aussi physiopathologiques. En effet, le contrôle des facteurs de risque comme le tabagisme, le surpoids et l’hypertension artérielle pourrait non seulement prévenir les MCV, mais également la DE. La relation est très forte chez les patients diabétiques, pour lesquels toute DE pourrait être considérée comme élément permettant d’identifier les patients à risque de maladie cardiaque silencieuse.

D’un point de vue physiopathologique, les vaisseaux péniens de petit calibre montrent des signes d’obstruction plus tôt car ils sont plus sensibles aux modifications hémodynamiques, même mineures. De plus, il y a une corrélation significative entre la sévérité de la DE et le nombre de vaisseaux touchés chez les patients porteur d’une maladie coronaire. La dysfonction endothéliale est le dénominateur commun à ces pathologies et représente ainsi une cause majeure de DE.

Au niveau thérapeutique, des études préliminaires ont montré que les IPDE-5 réduiraient les symptômes, permettraient d’améliorer la tolérance à l’exercice, et de réduire la dysfonction endothéliale des patients ayant eu un arrêt cardiaque et en cas de diabète.

La DE pourrait ainsi dans les années à venir s’ajouter aux facteurs de risque classiques et caractériser une population à risque accru de maladie coronaire.

Abstract

Erectile dysfunction (ED) affects approximately 100 million men in the world and 50% of men between the ages of 40 and 70 years. The commonest cause is a vascular disorder of penile arteries. ED may therefore be a an early marker of cardiovascular disease (CVD).

The main arguments in favour of this assertion are primarily epidemiological, but also pathophysiological, as control of cardiovascular risk factors such as smoking, obesity and hypertension may prevent not only CVD, but also ED. This relationship is particularly strong in diabetic patients, in whom ED can be considered to be an element able to identify patients at risk of asymptomatic heart disease.

From a pathophysiological point of view, small calibre penile vessels present signs of obstruction earlier than larger vessels because they are more sensitive to even minor haemodynamic changes. There is also a significant correlation between the severity of ED and the number of vessels affected in patients with coronary artery disease. Endothelial dysfunction is the common denominator underlying these diseases and therefore represents a major cause of ED.

Preliminary studies have shown that PDE-5 inhibitors can reduce symptoms, improve exercise tolerance, and reduce endothelial dysfunction in patients after cardiac arrest and in diabetics.

In the years to come, ED may therefore be added to the classical cardiovascular risk factors and could characterize a population with an increased risk of coronary artery disease.

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Correspondence to Francis Dubosq.

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Bourse SALF 2005

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Dubosq, F., Lebret, T., Guiomard, A. et al. La dysfonction érectile, un marqueur précoce d’atteinte cardio-vasculaire. Androl. 16, 24–27 (2006) doi:10.1007/BF03034828

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Mots-clés

  • dysfonction érectile
  • maladie coronaire
  • facteur de risque cardiovasculaire

Key-words

  • erectile dysfunction
  • coronary artery disease
  • cardiovascular risk factors