Metabolic risk factors, endothelial dysfunction, and erectile dysfunction in men with diabetes

BACKGROUND: The prevalence of men with erectile dysfunction (ED) and concomitant diabetes mellitus continues to increase. ED, diabetes, hypertension, and dyslipidemia (components of the metabolic syndrome) are associated with endothelial dysfunction. ED has been reported to be a marker for cardiovascular arterial disease. Effective treatment of ED requires recognition of the condition and its associated comorbidities, including endothelial dysfunction. METHODS: An electronic search of the literature was conducted to review information concerning the prevalence of ED, diabetes, metabolic syndrome, endothelial dysfunction, and treatment of ED. RESULTS: Phosphodiesterase type 5 (PDE5) inhibitors are effective vasodilating agents with a predominant effect on penile vasculature and are therefore first-line treatment for men with ED. These agents have also been demonstrated to have a beneficial effect in other vascular beds. PDE5 inhibitors have not been shown to have an adverse effect on cardiovascular morbidity or mortality or on glycemic control in men with diabetes. In addition, no causal association has been established between nonarteritic ischemic optic neuropathy and PDE5 inhibitors. CONCLUSIONS: PDE5 inhibitors have a beneficial effect on endothelial dysfunction and ED in men with diabetes and metabolic risk factors.