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

Andrologie volume 16, pages 24–27 (2006)Cite this article

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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.

References

  1. BOCCHI E.A., GUIMARÃES G., MOCELIN A. et al.: Sildenafil effects on exercise, neurohormal activation, and erectile dysfunction in congestive heart. Circulation, 2002, 106: 1097–1103.

    Article  PubMed  Google Scholar 

  2. CHEW K.K., EARLE C.M., STUCKEY B.G.A. et al.: Erectile dysfunction in general medicine practice: prevalence and clinical correlates. Int. J. Impot. Res., 2000, 12: 41–45.

    Article  PubMed  CAS  Google Scholar 

  3. DE ANGELIS L., MARFELLA M.A., SINISCALCHI M., et al.: Erectile and endothelial dysfunction in type II diabetes: a possible link. Diabetologia, 2001, 44: 1155–1160.

    Article  PubMed  Google Scholar 

  4. DESOUZA C., PARULKAR A., LUMPKIN D. et al.: Acute and prolonged effects of sildenafil on brachial artery flow-mediated dilatation in type 2 diabetes. Diabet Care, 2002, 25: 1336–1339.

    Article  CAS  Google Scholar 

  5. FUNG M.M., BETTENCOURT R., BARRETT-CONNOR E.: Heart disease risk factors predict erectile dysfunction 25 years later. The Rancho Bernardo Study. J. Am. Coll. Cardiol., 2004, 43: 1405–1411.

    Article  PubMed  Google Scholar 

  6. GAZZARUSO C., GIORDANETTI S., DE AMICI E. et al.: Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation, 2004, 110: 22–26.

    Article  PubMed  Google Scholar 

  7. GREENSTEIN A., CHEN J., MILLER H et al.: Does severity of ischemic coronary disease correlate with erectile function? Int. J. Impot. Res., 1997, 9: 123–126.

    Article  PubMed  CAS  Google Scholar 

  8. JENSEN J., LENDORF A., STIMPEL H. et al.: The prevalence and etiology of impotence in 101 male hypertensive outpatients. Am. J. Hypertens., 1999, 12: 271–275.

    Article  PubMed  CAS  Google Scholar 

  9. JUNEMANN K.P., AUFENANGER J., KONRAD T. et al.: The effect of impaired lipid metabolism on the smooth muscle cells of rabbits. Urol. Res., 1991, 19: 271–275.

    Article  PubMed  CAS  Google Scholar 

  10. KAISER D.R., BILLUPS K., MASON C. et al.: Impaired brachial artery endothelium-dependent and independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J. Am. Coll. Cardiol., 2004, 43: 179–184.

    Article  PubMed  Google Scholar 

  11. KATZ S.D., BALIDEMAJ K., HOMMA S. et al.: Acute type 5 phosphodiesterase inhibition with sildenafil enhances flowmediated vasodilation in patients with chronic heart failure. J. Am. Coll. Cardiol., 2000, 36: 845–851.

    Article  PubMed  CAS  Google Scholar 

  12. KHAN M.A., LEDDA A., MIKHAILIDIS D.P. et al.: Consensus Writing Committee. Second Consensus Conference on Cardiovascular Risk Factors and Erectile Dysfunction. Curr. Med. Res. Opin., 2002, 18: 33–35.

    Article  PubMed  CAS  Google Scholar 

  13. LAUMANN E.O., PAIK A., ROSEN R.C.: Sexual dysfunction in the United States: Prevalence and predictors. J. Am. Med. Ass., 1999, 281: 537–544.

    Article  CAS  Google Scholar 

  14. LUE T.F.: Erectile dysfunction. N. Engl. J. Med., 2000, 342: 1802–1813.

    Article  PubMed  CAS  Google Scholar 

  15. MCVARY K.T., CARRIER S., WESSELLS H.: Subcommittee on Smoking and Erectile Dysfunction Socioeconomic Committee, Sexual Medicine Society of North America. Smoking and erectile dysfunction: evidence based analysis J. Urol., 2001, 166: 1624–1632.

    Article  PubMed  CAS  Google Scholar 

  16. MICHELAKIS E., TYMCHAK W., LIEN D. et al.: Oral sildenafil is an effective and specific pulmonary vasodilator in patients with pulmonary artery hypertension comparison with inhaled nitric oxide. Circulation, 2002, 105: 2398–2403.

    Article  PubMed  CAS  Google Scholar 

  17. 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: 360–365.

    Article  PubMed  Google Scholar 

  18. MONTORSI P., MONTORSI F., SCHULMAN C.C.: Is erectile dysfunction the “tip of the iceberg” of a systemic vascular disorder? Eur. Urol., 2003, 44: 352–354.

    Article  PubMed  Google Scholar 

  19. O’KANE P.D., JACKSON G.: Erectile dysfunction: is there silent obstructive coronary artery disease? Int. J. Clin. Pract., 2001, 55: 219–220.

    PubMed  CAS  Google Scholar 

  20. PARAZZINI F., MENCHINI F., FABRIS F. et al.: Frequency and determinants of erectile dysfunction in Italy. Eur. Urol., 2000, 37: 43–49.

    Article  PubMed  CAS  Google Scholar 

  21. ROSANO G.M., AVERSA A., VITALE C. et al.: Chronic treatment with tadalafil improves endothelial function in men with increased cardiovascular risk. Eur. Urol., 2005, 47: 214–222.

    Article  PubMed  CAS  Google Scholar 

  22. SASTRY B.K.S., NARASIMHAN C., REDDY N.K. et al.: Clinical efficacy of sildenafil in primary pulmonary hypertension. Randomized, placebocontrolled, double-blind, crossover study. J. Am. Coll. Cardiol., 2004, 43: 1149–1153.

    Article  PubMed  CAS  Google Scholar 

  23. SOLOMON H., MAN J., WIERZBICKI A.S. et al.: Erectile dysfunction: cardiovascular risk and the role of cardiologist. Int. J. Clin. Practice, 2003, 57: 96–99.

    CAS  Google Scholar 

  24. SPEEL T.G., VAN LANGEN H., MEULEMAN E.J.: The risk of coronary heart disease in men with erectile dysfunction. Eur. Urol. 2003, 44: 366–371.

    Article  PubMed  CAS  Google Scholar 

  25. SULLIVAN M.E., KEOGHANE S.R., MILLER M.A.: Vascular risk factors and erectile dysfunction. Br. J. Urol. Int., 2001, 87: 838–845.

    CAS  Google Scholar 

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Authors and Affiliations

  1. Service d’Urologie, Hôpital Foch, Suresnes

    Francis Dubosq, Thierry Lebret & Henry Botto

  2. Service de Cardiologie, Hôpital Foch, Suresnes

    Alain Guiomard

  3. Service de Médecine nucléaire, Hôpital Foch, Suresnes

    Catherine Tainturier

Authors
  1. Francis Dubosq
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  2. Thierry Lebret
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  3. Alain Guiomard
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  4. Catherine Tainturier
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  5. Henry Botto
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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). https://doi.org/10.1007/BF03034828

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Basic and Clinical Andrology

ISSN: 2051-4190