亚临床血管疾病与随后的勃起功能障碍：动脉粥样硬化多民族研究（MESA）
Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA).
作者信息
Feldman David I, Cainzos-Achirica Miguel, Billups Kevin L, DeFilippis Andrew P, Chitaley Kanchan, Greenland Philip, Stein James H, Budoff Matthew J, Dardari Zeina, Miner Martin, Blumenthal Roger S, Nasir Khurram, Blaha Michael J
机构信息
Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
出版信息
Clin Cardiol. 2016 May;39(5):291-8. doi: 10.1002/clc.22530. Epub 2016 May 3.
BACKGROUND
The association between subclinical cardiovascular disease and subsequent development of erectile dysfunction (ED) remains poorly described.
HYPOTHESIS
Among multiple subclinical atherosclerosis and vascular dysfunction measurements, coronary artery calcium (CAC) score best predicts ED.
METHODS
After excluding participants taking ED medications at baseline, we studied 1862 men age 45 to 84 years free of known cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA) with comprehensive baseline subclinical vascular disease phenotyping and ED status assessed at MESA visit 5 (9.4 ± 0.5 years after baseline) using a standardized question on ED symptoms. Multivariable logistic regression was used to assess the associations between baseline measures of vascular disease (atherosclerosis domain: CAC, carotid intima-media thickness, carotid plaque, ankle-brachial index; vascular stiffness/function domain: aortic stiffness, carotid stiffness, brachial flow-mediated dilation) and ED symptoms at follow-up.
RESULTS
Mean baseline age was 59.5 ± 9 years, and 839 participants (45%) reported ED symptoms at follow-up. Compared with symptom-free individuals, participants with ED had higher baseline prevalence of CAC score >100 (36.4% vs 17.2%), carotid intima-media thickness Z score >75th percentile (35.3% vs 16.6%), carotid plaque score ≥2 (39% vs 21.1%), carotid distensibility <25th percentile (34.6% vs 17.1%), aortic distensibility <25th percentile (34.2% vs 18.7%), and brachial flow-mediated dilation <25th percentile (28.4% vs 21.3%); all P < 0.01. Only CAC >100 (odds ratio: 1.43, 95% confidence interval: 1.09-1.88) and carotid plaque score ≥2 (odds ratio: 1.33, 95% confidence interval: 1.02-1.73) were significantly associated with ED.
CONCLUSIONS
Subclinical vascular disease is common in men who later self-report ED. Early detection of subclinical atherosclerosis, particularly advanced CAC and carotid plaque, may provide opportunities for predicting the onset of subsequent vascular ED.
背景
亚临床心血管疾病与勃起功能障碍（ED）后续发生之间的关联仍描述不足。
假设
在多种亚临床动脉粥样硬化和血管功能障碍测量指标中，冠状动脉钙化（CAC）评分最能预测ED。
方法
在排除基线时服用ED药物的参与者后，我们对来自动脉粥样硬化多族裔研究（MESA）的1862名年龄在45至84岁、无已知心血管疾病的男性进行了研究，这些男性具有全面的基线亚临床血管疾病表型分析，并且在MESA第5次访视时（基线后9.4±0.5年）使用关于ED症状的标准化问题评估了ED状态。采用多变量逻辑回归来评估血管疾病基线测量指标（动脉粥样硬化领域：CAC、颈动脉内膜中层厚度、颈动脉斑块、踝臂指数；血管僵硬度/功能领域：主动脉僵硬度、颈动脉僵硬度、肱动脉血流介导的扩张）与随访时ED症状之间的关联。
结果
平均基线年龄为59.5±9岁，839名参与者（45%）在随访时报告有ED症状。与无症状个体相比，患有ED的参与者基线时CAC评分>100的患病率更高（36.4%对17.2%）、颈动脉内膜中层厚度Z评分>第75百分位数的患病率更高（35.3%对16.6%）、颈动脉斑块评分≥2的患病率更高（39%对21.1%）、颈动脉扩张性<第25百分位数的患病率更高（34.6%对17.1%）、主动脉扩张性<第25百分位数的患病率更高（34.2%对18.7%）以及肱动脉血流介导的扩张<第25百分位数的患病率更高（28.4%对21.3%）；所有P<0.01。只有CAC>100（比值比：1.43，95%置信区间：1.09 - 1.88）和颈动脉斑块评分≥2（比值比：1.33，95%置信区间：1.02 - 1.73）与ED显著相关。
结论
亚临床血管疾病在后来自我报告有ED的男性中很常见。早期检测亚临床动脉粥样硬化，尤其是严重的CAC和颈动脉斑块，可能为预测随后血管性ED的发生提供机会。
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