P4456Association between glucose metabolic status and global arterial function and early structural changes in men with erectile dysfunction

Abstract

Background: Erectile dysfunction (ED) is associated with generalized vascular disease, particularly among middle-aged men with risk factors. Moreover, there are no data on the possible differentiation of microvascular and macrovascular changes among patients with ED according to glucose metabolism. Methods: We studied 568 patients with ED and we assessed vascular damage according to glucose metabolic status in three groups (Group 1, normal glucose metabolism (NG, n=388); Group 2, impaired fasting glucose (IFG, n=76); and Group 3, type II diabetes mellitus (DM, n=104)). Macrovascular damage was assessed with arterial stiffness by measuring carotid-femoral pulse wave velocity (PWV) and with carotid atherosclerosis by measuring carotid intima media thickness (IMT). Microvascular damage was assessed with penile vascular function by measuring penile peak systolic velocity (PSV) with a dynamic penile color Doppler ultrasonography after intracavernous injection of prostanglandin E1. Lower PSV values indicate severe penile vascular disease. Results: The mean age was similar and the prevalence of dyslipidemia and smoking was not different between the three study groups. Systolic and pulse pressure were higher in DM patients compared to patients with IFG and subjects with NG (P<0.01). Total testosterone (TT) was lower and high sensitivity C reactive protein (CRP) was higher among DM and IFG patients compared to subjects with NG (P<0.001 and P<0.01, respectively). There was a significant progressive increase in PWV from group NG to IFG and DM groups (from 8.41 to 8.74 to 9.14 m/s, respectively) that remained statistically significant even after adjustment for blood pressure level, CRP and TT (P<0.01, by ANCOVA). DM and IFG patients had comparable mean carotid IMT and significantly higher value compared to that of men with NG (0.92 vs 0.88 vs 0.80 mm, respectively, P<0.001, by ANCOVA). There was a significant progressive decrease in penile PSV from group NG to IFG and DM groups (from 34.2 to 31.5 to 29.5 cm/s, respectively) that remained statistically significant after adjustment for confounders (P<0.05, by ANCOVA). Conclusions: Vascular alterations among ED patients differ according to the grade of glucose dysregulation. Considering the adverse prognostic role of high aortic PWV, high carotid IMT and low PSV, it might be argued that the cardiovascular risk is not homogeneously distributed among ED patients but is largely determined by glucose metabolic status.