ED: First Warning Sign of Silent Cardiovascular Disease?
A detailed medical history, including sexual and psychosocial history and an updated list of the medications, should be obtained from any patient seeking help for ED. As mentioned earlier, because of the close association between cardiovascular risk factors and ED, searching for potential cardiovascular disorders in these patients appears worth-while. In some cases, ED may be a warning sign of silent cardiac disease before symp-toms of heart disease are present. Among patients with type 2 diabetes mellitus, ED was identified as a highly efficient predictor of silent coronary artery disease apart from traditional risk factors such as smoking, micro-albuminuria, and lipid abnormalities.
Furthermore, a strong association between endothelial dysfunction of peripheral arteries (measured as vasodilation of the brachial artery) and first symptoms of ED appears to exist even before manifestation of atherosclerotic disease. Because endothelial dys-function generally is supposed to precede the morphological development of atheroscle-rotic lesions, this association might suggest that the presence of ED can predict the development of atherosclerotic disease in a very early stage of the pathogenesis of athero-sclerotic disease. On the other hand, endothelial dysfunction and impaired vascular func-tion may also play a causal role in the development of ED.