Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Eur Neurol 2008;60:85–88 DOI: 10.1159/000136653 Cerebral Vasomotor Reactivity Is Reduced in Patients with Erectile Dysfunction Edoardo Vicenzini a Marta Altieri a Paolo Maria Michetti b Maria Chiara Ricciardi a Mauro Ciccariello b Hossein Shahabadi b Francesco Puccinelli a Gian Luigi Lenzi a Vittorio Di Piero a Departments of a Neurological Sciences and b Urology, University of Rome, La Sapienza, Rome, Italy Introduction Erectile dysfunction (ED) is not only evidence of dif- fuse atherosclerosis, but, in men without clinical signs of atherosclerosis, it is also an early predictor of future car- diovascular events and coronary artery disease [1]. This association has indeed been strengthened by the observa- tion that the severity of ED is correlated with the angio- graphic extension of the coronary atherosclerotic process [2]. According to these findings, men with ED are at po- tential risk for developing cardiovascular disease. While the vascular etiology of ED is clear in patients with atherosclerotic disease in an advanced phase, the as- sociation of ED with a vascular damage in men without clinical signs of atherosclerosis is still object of study [3]. An altered systemic endothelial cell dysfunction has been hypothesized in the presence of ED, independently of the coexisting vascular risk factors, and this impairment may represent an early sign of systemic vascular damage with ED as the only clinical correlate [4]. In this view, an in- creased intima-media thickness (IMT) of the common carotid arteries, a marker of systemic atherosclerosis, is correlated with the risk of ED and with its severity [5]. Cerebrovascular reactivity evaluates the cerebral en- dothelial function, providing information on the cere- brovascular reserve capacity. In a recent study, Diomedi et al. [6] observed an increase in cerebrovascular reactiv- ity after sildenafil administration in patients with ED. Key Words Erectile dysfunction  Cerebrovascular reactivity  Transcranial Doppler  Atherosclerosis Abstract Backgrounds: Erectile dysfunction (ED) is not only evidence of diffuse atherosclerosis but also an index of early endothe- lial damage. We investigated cerebrovascular reactivity, ex- pression of early arterial damage, in patients with isolated ED (ED+) and controls (ED–). Materials and Methods: Fifteen ED+ and 15 ED– subjects, matched for age (ED+: 58 86, ED–: 59 8 4 years) and vascular risk factors, were submitted to ca- rotid duplex ultrasound and transcranial Doppler. Cerebro- vascular reactivity was assessed on both middle cerebral ar- teries simultaneously calculating (a) the total vasomotor range (VMR) measured after breath holding and hyperventi- lation and (b) the rate of change (VMR/CO 2 ) after breath hold- ing. Results: Carotid Duplex scanning showed a light carotid stenosis only in 3 (2 in the ED+ and 1 in the ED– group). No differences were observed in intima-media thickness be- tween ED+ and ED–. Slightly slower mean middle cerebral artery flow velocities were observed in ED+ with respect to ED–. ED+ patients showed a reduced VMR (p ! 0.001) and a slower VMR/CO 2 rate of change (p ! 0.001) compared to ED–. Conclusions: The reduced reactivity in patients with isolated ED may represent a marker of early cerebral vasomo- tor dysfunction due to subclinical endothelial damage. Copyright © 2008 S. Karger AG, Basel Received: October 26, 2007 Accepted: January 6, 2008 Published online: June 5, 2008 Edoardo Vicenzini Department of Neurological Sciences, University of Rome, La Sapienza Viale dell’Università 30, IT–00185 Rome (Italia) Tel. +39 06 4991 4705, Fax +39 06 4991 4194, E-Mail edoardo.vicenzini@uniroma1.it © 2008 S. Karger AG, Basel 0014–3022/08/0602–0085$24.50/0 Accessible online at: www.karger.com/ene