Strategies to improve endothelial function and its clinical relevance to erectile dysfunction

Context: Erectile dysfunction (ED) is often the manifestation of a generalized vascular disorder characterized by endothelial dysfunction. Reduced biological activity of endothelium-derived nitric oxide links human atherosclerosis to ED and underscores the role of an altered endothelium in the pathogenesis of both conditions. Objective: This review will provide an update on clinical data available on drugs promoting endothelial health and repair with regard to sexual medicine. Evidence acquisition: A comprehensive evaluation of available published data in full-length papers, identified in MedLine up to February 2008, was performed. Evidence synthesis: Evidence indicates that angiotensin-converting-enzyme inhibitors, sartanes, statins, vitamins (C and E), and L-arginine are all effective drugs for improving endothelial dysfunction in clinical studies; real benefits of dietary vitamin supplements and nutraceuticals are questionable. Growing evidence suggests that continued use of phosphodiesterase type 5 inhibitors as well as adjunctive testosterone replacement in deficiency syndromes may be beneficial and may synergistically improve endothelial function in selected subjects. Conclusions: Endothelially active drugs may serve as active treatment for both general and sexual health in men with increased cardiovascular risk. Further controlled studies are necessary to establish the real cost-effectiveness of such therapies and their impact on outcomes for patients.