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Also known as
Arterial sclerosis, arteriosclerotic vascular disease, hardening of the arteries, coronary artery disease (when affecting coronary arteries), arterial plaque buildup, atheromatous arterial disease
Definition
Atherosclerosis is a progressive cardiovascular disease characterized by the buildup of fatty deposits, cholesterol, cellular waste products, calcium, and other substances (collectively known as plaque) in the inner lining of arteries.1 This accumulation causes the arterial walls to thicken and harden, gradually narrowing the arterial lumen and reducing blood flow to vital organs and tissues.2 As the disease progresses, the reduced blood flow can lead to various clinical manifestations, including erectile dysfunction, which occurs when inadequate blood supply reaches the penile tissues.3
The pathophysiology involves endothelial dysfunction, inflammation, lipid accumulation, and smooth muscle cell proliferation, creating a cycle of arterial damage and repair that ultimately leads to significant vascular compromise.4 Atherosclerosis can affect virtually any artery in the body, including the coronary, carotid, peripheral, and penile arteries, making it a systemic disease with diverse clinical presentations.5
Clinical Context
Atherosclerosis plays a significant role in erectile dysfunction (ED) pathophysiology, as adequate penile blood flow is essential for achieving and maintaining erections.1 The connection between atherosclerosis and ED is well-established in clinical practice, with ED often preceding other cardiovascular manifestations by 2-5 years, making it a potential early warning sign of systemic vascular disease.3
Patient selection for atherosclerosis screening should include men presenting with ED who have cardiovascular risk factors such as hypertension, dyslipidemia, diabetes mellitus, obesity, smoking history, or family history of premature cardiovascular disease.4 The clinical approach involves comprehensive cardiovascular risk assessment, including lipid profiles, blood pressure measurement, and potentially non-invasive vascular studies such as brachial-ankle pulse wave velocity measurement.1
Treatment strategies focus on risk factor modification through lifestyle changes (smoking cessation, weight management, regular physical activity) and pharmacological interventions targeting dyslipidemia, hypertension, and hyperglycemia.2 Phosphodiesterase type 5 (PDE5) inhibitors are commonly prescribed for ED management but should be used cautiously in patients with severe cardiovascular disease.4 Importantly, any lifestyle change that improves heart health typically improves erectile function as well, highlighting the systemic nature of atherosclerotic disease.4