A Longitudinal Study of Endothelial Function and Erectile Dysfunction

描述（由申请人提供）： 勃起功能障碍（艾德）是一种高度流行的疾病，估计在美国影响1000万至2000万男性。有大量证据表明艾德与心血管疾病（CVD）有关，这意味着共同的潜在血管疾病。由于勃起系统的血管系统比全身导管血管更早地表现出血管舒张的进行性丧失，因此对公共卫生的重要意义是艾德可能作为即将发生的CVD的警告信号。最近来自马萨诸塞州男性衰老研究的发现表明，艾德症状的缓解比以前认为的更常见，多达三分之一的艾德男性报告自发缓解。以一氧化氮（NO）丢失为特征的内皮功能障碍是艾德和CVD的生物学机制，并且已被证明先于动脉粥样硬化。然而，缺乏内皮功能障碍对艾德的发病率、进展和缓解的影响的纵向数据，因此艾德在心脏病预防干预中的作用仍不确定。本研究的目的是首次在男性大样本人群中对内皮功能障碍和艾德之间的前瞻性关系进行系统研究。拟议的研究是波士顿地区社区健康（BACH）调查的辅助研究，这是一项广泛的泌尿系统症状的流行病学研究，包括基线时年龄为30-79岁的2，301名种族/种族多样化男性。拟议研究的参与者将从BACH/骨队列中招募，这是一项在随机选择的1，219名黑人、西班牙裔和白色BACH男性中进行的关于肌肉骨骼健康的BACH辅助研究。将使用前臂肱动脉血流介导的舒张（FMD）（一种常用于评估内皮功能障碍的指标）测量400名男性的内皮功能。基线评估将在2年时使用相同的测量值进行随访。本研究将经济有效地利用关于母BACH研究及其辅助研究BACH/Bone的充分表征队列的背景人口统计学、生物医学和心理社会学数据。 公共卫生相关性：心血管疾病是美国成年人过早死亡的最重要原因，勃起功能障碍可能是血管疾病的早期指标，可用于临床识别高风险男性作为干预措施的候选人，以降低未来心血管事件的风险。由于目前还没有关于勃起功能障碍和内皮功能障碍的纵向评估的研究，因此拟议的研究可能会在这一领域提供新的信息。

DESCRIPTION (provided by applicant): Erectile dysfunction (ED) is a highly prevalent condition estimated to affect 10-20 million men in the US. There is a substantial body of evidence linking ED and cardiovascular disease (CVD), implying a common underlying vascular disease. As progressive loss of vasodilation manifests sooner in the vasculature of the erectile system than in systemic conduit vessels, an important implication for public health is that ED may act as a warning signal for impending CVD. Recent finding from the Massachusetts Male Aging Study have shown remission of ED symptoms to be more common then previously thought with up to one-third of men with ED reporting spontaneous remission. Endothelial dysfunction, characterized by loss of nitric oxide (NO), is the biologic mechanism underlying ED and CVD and has been shown to precede atherosclerosis. However, longitudinal data on the impact of endothelial dysfunction on the incidence, progression, and remission of ED are lacking, and thus the role of ED in preventive interventions for heart disease remains inconclusive. The goal of the proposed research is to provide the first systematic investigation of the prospective relationship between endothelial dysfunction and ED in a large population-base sample of men. The proposed study is an ancillary study of the Boston Area Community Health (BACH) survey, an epidemiologic study of a broad range of urologic symptoms, that includes a cohort of 2,301 race/ethnically diverse men age 30-79 at baseline. Participants in the proposed study will be recruited from the BACH/Bone cohort, an ancillary study of BACH on musculoskeletal health in a randomly selected group of 1,219 black, Hispanic, and white BACH men. Endothelial function will be measured in 400 men using forearm brachial artery flow mediated dilation (FMD), a measure commonly used to assess endothelial dysfunction. A baseline assessment will be followed up at 2 years with the same measurements. The present study will cost-efficiently draw on the wealth of background demographic, biomedical and psychosocial data on the well-characterized cohort of the parent BACH study and its ancillary study, BACH/Bone. Public Health Relevance: Cardiovascular disease is the most important cause of premature death in the adult population of the U.S. and erectile dysfunction may be an early indicator of vascular disease that could be clinically useful for identification of higher risk men as candidates for interventions to reduce risk of future cardiovascular events. As there are no existing studies of longitudinal assessments of both erectile dysfunction and endothelial dysfunction, the proposed study is likely to provide new information in this area.