Jackson G
Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Int J Impot Res. 2008 Dec;20 Suppl 2:S9-14. doi: 10.1038/ijir.2008.47.
Both erectile dysfunction (ED) and vascular disease share the same risk factors and the two conditions often coexist, with endothelial dysfunction being the common underlying pathophysiology. Up to two-thirds of all patients with clinically evident coronary artery disease (CAD) have ED. Because of their smaller size, the same degree of lipid plaque burden has a greater effect on the penile arteries compared with the coronary arteries. As a result, the clinical consequences of penile vascular disease (ED) frequently manifest 2-3 years before the consequences of coronary atherosclerosis. This phenomenon has led to the widespread view that ED is a silent marker of vascular disease, particularly CAD, in otherwise asymptomatic men. The Second Princeton Consensus Guidelines reflect this by stating that a man with ED and no cardiac symptoms should be considered a cardiac (or vascular) patient until proven otherwise. For most men with no cardiac symptoms, we therefore have 2-3 years from ED onset to reduce the risk of a cardiovascular event. This article discusses the rationale for the link between ED and CAD, with reference to endothelial dysfunction, and the role of ED as an important means of identifying men at risk of vascular disease.
勃起功能障碍（ED）和血管疾病具有相同的风险因素，且这两种病症常常并存，内皮功能障碍是共同的潜在病理生理学机制。临床上明显患有冠状动脉疾病（CAD）的患者中，多达三分之二患有ED。由于阴茎动脉尺寸较小，相同程度的脂质斑块负荷对阴茎动脉的影响比对冠状动脉的影响更大。因此，阴茎血管疾病（ED）的临床后果通常在冠状动脉粥样硬化后果出现前2至3年就会显现。这种现象导致了一种广泛的观点，即在无症状男性中，ED是血管疾病尤其是CAD的一个无声标志物。《第二届普林斯顿共识指南》也体现了这一点，该指南指出，患有ED且无心脏症状的男性在未被证明无病之前应被视为心脏病（或血管病）患者。因此，对于大多数无心脏症状的男性而言，从ED发病起我们有2至3年的时间来降低心血管事件的风险。本文结合内皮功能障碍，探讨了ED与CAD之间联系的基本原理，以及ED作为识别血管疾病风险男性的重要手段所起的作用。
