Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Men with aortoiliac atherosclerosis exhibit organic erectile dysfunction caused by inadequate blood flow and/or psychological factors. After aortoiliac reconstruction, organic erectile dysfunction may be due primarily to surgical interruption of autonomic nerve fibers. To avoid this, dissection principles preserving genital autonomic plexi were developed. The results of these dissections were compared with those of conventional bypasses. Thirty nondiabetic men (age range, 43 to 67 years) were studied. A history of erectile capacity was elicited preoperatively and evaluated postoperatively in follow-up interviews every six months. Normal postoperative erectile function was not affected by nerve-sparing dissections. Each of the 11 patients requiring conventional dissections was both preoperatively and postoperatively impotent. Four of the 19 patients who underwent nerve-sparing dissection were preoperatively and postoperatively impotent. Seven of these 19 patients maintained preoperative potency after nerve-sparing dissection. The potency of the remaining eight patients was either completely restored or improved after nerve-sparing dissection. This report emphasizes the importantance of a preoperative determination of a complex interplay of physical and psychological factors in erectile dysfunction.
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PMID:Preservation of erectile function after aortoiliac reconstruction. 68 91

An animal model was developed to study the pathophysiology of erectile dysfunction due to atherosclerotic vascular disease. Thirty one New Zealand white male rabbits were divided into control (n = 5) and treatment groups (n = 26). The control group was placed on a regular diet while the treatment group underwent balloon de-endothelialization of the aorto-iliac arteries and received 1.6% cholesterol and 4% triglyceride diet for eight weeks. After eight weeks in the control animals (n = 5), blood levels of cholesterol, triglycerides and low density lipoproteins, radiologic studies as well as hemodynamic parameters of erectile function were all normal. In the surviving treatment animals (n = 21) after the same time period, a significant increase in blood levels of cholesterol, triglyceride and low density lipoprotein were observed. In addition, 62% of these animals developed hypertension which was not observed in the control group. Angiographically, 10 animals (48%) demonstrated severe atherosclerotic lesions (75% to 100% occlusion of common or internal iliac arteries on one side and over 50% occlusion of the opposite side), five (24%) had moderate lesions (50 to 75% luminal occlusion of right and left common iliac or internal iliac arteries) and 6 revealed minimal lesions (less than 50% occlusion of the right and left common iliac or internal iliac arteries). Of the 15 animals with 50% or greater luminal occlusion of the iliohypogastric arteries, erectile dysfunction was found in 93% of cases. Due to the development of erectile dysfunction in 33% of animals with minimal occlusive lesions, it appears that factors, other than large vessel luminal occlusion, may exist in this animal model which adversely influence erectile function. This model may therefore be of further benefit in the study of other factors associated with atherosclerosis and impotence, such as the possible concomitant hypercholesterolemic and atherosclerotic-induced alterations in the local reactivity of corpus cavernosum smooth muscle and lacunar space endothelial cells.
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PMID:Erectile dysfunction due to atherosclerotic vascular disease: the development of an animal model. 159 19

A substantial number of young men with erectile dysfunction have neither systemic disease nor a trauma in their history. We are familiar with impotence after major trauma but it is an unanswered question whether subclinical trauma may also induce arterial degeneration with subsequent erectile dysfunction. In a period of 36 months 129 patients underwent penile arteriography. After excluding those with major surgery, trauma or psychogenic impotence 91 angiograms were reevaluated. Special attention was paid to atherosclerotic and to focal occlusive arterial disease (> 50% stenosis) in the hypogastric-cavernous branch. 12 angiograms showed normal arteries, 59 typical atherosclerotic and 20 focal occlusive arterial disease. The mean age of patients with atherosclerosis was 53 +/- 8 years versus 35 +/- 14 years of those with focal lesions (p < 0.0001). 30% with focal arterial lesions were subject to subclinical trauma. 68% with atherosclerotic disease had clinical relevant atherosclerotic risk factors. Latency between onset of erectile dysfunction and presentation at the impotence clinic was 51 months in patients with focal lesions and 39 months in those with atherosclerotic disease (nonsignificant). We conclude that subclinical trauma of the hypogatric-cavernous arteries can induce focal arterial lesions with significant impairment of perfusion. This pathology may contribute to erectile dysfunction. These patients are significantly younger and they suffer from clinically evident impotence approximately 18 years earlier than patients whose impotence is clearly of atherosclerotic origin. Focal arterial lesions due to subclinical trauma are described for the first time as an etiology of erectile dysfunction. Further studies are needed to confirm these results.
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PMID:Subclinical trauma to perineum: a possible etiology of erectile dysfunction in young men. 765 7

The understanding of pharmacology of impotence has shown a steady improvement over the last 15 years which has resulted in a better appreciation of the neurovascular mechanisms of the erectile process especially at the level of the corpora cavernosa; however, central mechanisms which control libido and erection are not yet completely elucidated. Frequent diseases most commonly encountered in elderly patients--i.e. diabetes, hypertension, atherosclerosis, depression, etc--represent a frequent cause of erectile dysfunction (ED) and are treated with medications that can interfere with sexual functioning at the central and/or peripheral level. Antidepressants, including the tricyclics and the monoamine oxidase inhibitors, have been implicated in ED, decreased libido, and impaired ejaculation. Most antihypertensives have been associated with some erectile impairment, but diuretics seem to have little effect on erectile function. The calcium channel blockers and ACE inhibitors are associated with a low incidence of ED. Sympatholytic antihypertensives seldom cause importence but can cause retrograde ejaculation because of the relaxation of the smooth muscles in the prostatic urethra and bladder neck. The most commonly prescription drugs that can affect sexual function are briefly discussed and an integrated pharmacological approach to the patient with drug-induced ED is proposed.
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PMID:[Pharmacology of male sexual dysfunction]. 969 33

Erectile dysfunction and impotence has a high prevalence among male hypertensive patients. Whether this relates mainly to specific drug side effects or to primary pathogenic disorders is unknown. In the present study 101 male patients from our outpatient hypertension clinic answered detailed questionnaires about hypertension and sexual function. Patients with perceived impotence were offered a thorough penile evaluation and examination performed by specialists in the urology department. Twenty-seven (27%) men had impotence. The main cause of impotence was an arterial dysfunction (89%). The prevalence of impotence was related to the degree of secondary organ manifestation, reflected by World Health Organization (WHO) classification I-III (P = .01). Intermittent claudication (P = .001) and ischemic heart disease (P = .005) were the best determinants in this respect. Twelve impotent patients (44%) ascribed onset of impotence to drug initiation. A variety of drugs were incriminated in the occurrence of drug-induced impotence. In summary our results indicate that impotence in hypertensive men is caused mainly by penile arterial vascular changes, probably atherosclerosis. Drug-induced impotence could well be the result of blood pressure reduction itself and not specific drug side effects.
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PMID:The prevalence and etiology of impotence in 101 male hypertensive outpatients. 1019 29

Both animal and human penile tissue synthesize prostaglandins (PGs). Furthermore, intracavernous injection of certain PGs elicits erection in men with erectile dysfunction (ED). It is also well established that PGs are involved in the pathophysiology of atherosclerosis and diabetes mellitus (DM). Since atherosclerosis and DM are major risk factors for ED, it has been suggested that the disruption of PG synthesis in penile tissues and related vasculature may play a role in the pathogenesis of ED. In this review, we discuss the role of PGs in normal penile erection as well as on the pathophysiology and treatment.
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PMID:The role of prostaglandins in the aetiology and treatment of erectile dysfunction. 1035 18

Patients with cardiovascular disease are at increased risk of developing erectile dysfunction (ED). This may be a consequence of atherosclerosis of the penile arteries, a reduced cardiac output, or a side-effect of drugs used to reduce cardiovascular risk factors (particularly beta-blockers, thiazide diuretics and, occasionally, lipid-lowering drugs). ED is a distressing condition, which often diminishes the patient's self-esteem, with the potential for damage to his psychological health and his relationship with his partner and family. When treating ED, the underlying aetiology should be established by careful examination and consideration of medical history and concurrent medication. Until recently, pharmacological treatment options involved intracavernous injections (alprostadil or moxisylyte) or intraurethral alprostadil. These treatments are often inconvenient and not well accepted by the patient. The recent introduction of oral sildenafil promises to revolutionise the treatment of ED. In double-blind, placebo-controlled trials in patients with ED, sildenafil improved erectile function and quality of life and was well tolerated. ED is a clinically important complication of cardiovascular disease and should be asked about and treated accordingly. It is important that effective treatments, including sildenafil, should be available for treating patients with cardiovascular disease and ED.
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PMID:Erectile dysfunction and cardiovascular disease. 1069 93

The cardiovascular response to coitus and the risk of an acute cardiac event related to sexual activity is of clinical importance, especially now that effective pharmacologic treatment of male erectile dysfunction permits older men to resume active sex lives. Early studies by Masters and Johnson of young subjects engaging in coitus in laboratory settings reported that heart rates and systolic blood pressures were at near maximum exercise levels. Subsequent data from studies by Hellerstein and Friedman and by Stein in men with coronary artery disease, using ambulatory electrocardiographic recordings during coitus at home, demonstrated significantly lower heart rate and blood pressure responses to coitus. The associated myocardial oxygen demand of coitus in these men was found to in the range of moderate activities, often achieved or exceeded during their workday. The cardiovascular risk of coitus was addressed in the recent ONSET study in which myocardial infarction (MI) patients were interviewed shortly after their MI about potential triggering activities or events. Coitus was noted to represent a very low absolute risk of being a trigger for MI, but had an increased relative risk of 2.5 for the subjects in their study. Sexual intercourse will, in most men, represent only a moderate "stress" on the heart in terms of the responses that impact on myocardial oxygen requirement (heart rates, and systolic blood pressure). In patients with coronary artery atherosclerosis, coitus, compared with vigorous physical activity and intense emotional responses, represents a small risk of triggering an acute MI.
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PMID:Cardiovascular response to sexual activity. 1089 74

The most common physical risk factors for erectile dysfunction (ED) are atherosclerosis, heart disease, hypertension and diabetes. Since accessibility to easy and efficacy drug for ED therapy, GPs are increasingly at the front line in the management of ED and are often best-placed to discuss this problem with cardiovascular male patients. This consensus aims to provide practical advice on the management of ED in patients with diagnosed cardiovascular disease and also addresses the assessment of the cardiovascular risk in restoring sexual activity in these patients. A risk assessment algorithm has been drawn up to aid clinicians in deciding the level of cardiovascular risk that would be associated with a return of sexual activity as well as criteria for referral to specialists for further cardiac evaluation. Treatment options are briefly reviewed and follow-up process identified.
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PMID:[Consensus on the clinical approach to erectile dysfunction in patients with cardiovascular disease]. 1094 13

Most studies have shown an increase in the prevalence of erectile dysfunction with ageing. Penile erection is a vascular phenomenon resulting from smooth muscle relaxation, arterial dilatation and venous restriction. The atherosclerosis of the penis that occurs with ageing causes a decrease in penile oxygen tension. This change in oxygen tension impacts directly upon both the physiologic function and the trabecular structure of the corpora cavernosa. Chronic ischaemia of the penis is associated with fibrosis of smooth muscle fibres and with endothelial and neuronal NO/cGMP pathways. The effects of androgens on libido and sexual behaviour are well established but their role in the erectile mechanism remains unclear. The histologic and haemodynamic causes responsible for the erectile decline in the ageing man are reviewed.
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PMID:Erectile dysfunction in the ageing man. 1114 37


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