Erectile Dysfunction as a Cardiovascular Impairment

Dedication

Reviews

Preface

References

Acknowledgments

Disclaimer

Chapter 1. Introduction

1.1 Erectile Dysfunction—as Presently Defined

1.2 The Aim and Scope of this Monograph

1.3 The Prevalence of Erectile Dysfunction

1.4 It is more complicated than the Standard American Diet

1.5 The Standard American Diet

1.6 An Important Note to the Reader

1.7 What Impairs Sexual Vitality?

1.8 Sexual Arousal and “Performance”

1.9 Erectile Dysfunction and Cardiovascular Disease

1.10 Erectile Dysfunction and Heart Disease

1.11 “Hypertension is Associated with Severe Erectile Dysfunction”

1.12 Erectile Dysfunction is Linked to Elevated Cholesterol and Coronary Heart Disease Risk

1.13 It’s also about Quality of Life

1.14 Declining Sexual Desire vs. Declining Performance

1.15 Diurnal Variation

1.16 The Acetylcholine/Nitric Oxide/Cyclic Guanosine Monophosphate Pathway

1.17 A Footnote to History

1.18 The Endothelium—the First Vascular Control Signal System

1.19 Vessels of the Vessels—Vasa Vasorum

1.20 Vasa Vasorum Depends Exclusively on Endothelium-Derived Vasorelaxation

1.21 The Penis

1.22 The Pathway to Penile Erection

1.23 Phosphodiesterase Type-5—Friend or Foe?

1.24 Cardiovascular Dysfunction and Sexual Dysfunction in Aging

1.25 Note on Terminology

References

Chapter 2. Measuring and Evaluating Function, Impairment, and Change with Intervention

2.1 Introduction

2.2 When Do We Know that We “Know” in Biological Science?

2.3 The Clinical Trial (or Clinical Study)

2.4 Note on Form of Citation

2.5 Note on Validity of Research Reports

2.6 Statistics Simplified

2.7 Hypertension

2.8 Hypertension—Paradoxically Beneficial in Erectile Dysfunction?

2.9 Atherosclerosis

2.10 Flow-Mediated (Vaso-)Dilation—A Window into Endothelial Health

2.11 Arteries and Aging

2.12 Blood Pressure/Hypertension

2.13 Cholesterol/Atherosclerosis

2.14 Heart Disease

2.15 Diabetes

2.16 Effect of Flow-Mediated Dilation Validation of the Cardiovascular Benefit of a Micronutrient

2.17 Penile Nitric Oxide Release Test—Flow-Mediated Dilation in Cavernosa Conduit Arteries

2.18 Echo Tracking Sonography

2.19 Ankle-Brachial Pressure Index

2.20 Procedure

2.21 Peripheral Arterial Tone Technology

2.22 The Augmentation Index

2.23 Peripheral Arterial Tone Methodology

2.24 Can We Measure Nitric Oxide Production Directly?

2.25 Measuring Penile Rigidity and Nocturnal Erection

2.26 The Brindley “Demonstration”

2.27 The International Index of Erectile Function

2.28 Nocturnal Penile Tumescence

2.29 Nocturnal Penile Tumescence and Rapid Eye Movement Sleep

2.30 Age-Related Decline in Nocturnal Penile Tumescence

2.31 Reliability of Nocturnal Penile Tumescence Testing

2.32 Cavernosa Peak Systolic Blood Flow Velocity

2.33 Penile Arterial Waveform Amplitude

2.34 Penile Brachial Index

References

Chapter 3. Cardiovascular Health Hazards Impairing Sexual Vitality

3.1 Introduction

3.2 Hypertension

3.3 Atherosclerosis

3.4 Cardiomyopathy and Arrhythmias

3.5 Coronary Artery Disease

3.6 Type-2 Diabetes

3.7 How Does Hypertension Cause Erectile Dysfunction?

3.8 Blood Pressure

3.9 How is Blood Pressure Regulated?

3.10 The Lymphatic System and Nitric Oxide Biosynthesis

3.11 Non-Endothelium-Dependent Blood Pressure Control

3.12 Aldosterone Activation and Erectile Dysfunction

3.13 Endothelium-Dependent Blood Pressure Regulation

3.14 Atherosclerosis

3.15 Plaque Growth and Vascular Remodeling

3.16 Typical Age-Related Progress of Atherosclerosis

3.17 What is the Connection between Atherosclerosis and Erectile Dysfunction?

3.18 Theories of Atherosclerosis

3.19 The Homocysteine Theory of Atherosclerosis and Erectile Dysfunction

3.20 The Vasa Vasorum Theory of Atherosclerosis and Erectile Dysfunction

3.21 How the Vasa Vasorum Theory of Atherosclerosis Differs from Previous Theories

3.22 The Vasa Vasorum Theory Could Take the Onus Off Dietary Cholesterol

3.23 The Cardiovascular System and the Heart

3.24 The Heart

3.25 Depression, Cardiovascular Disease, and Erectile Dysfunction

3.26 Dopamine Levels Decline with Age

3.27 Diabetes is Strongly Linked to Erectile Dysfunction

3.28 Diagnostic Clinical Criteria

3.29 Glycated (Glycosylated) Hemoglobin HbA1c

3.30 Prevalence of Diagnosed and Commonly Undiagnosed Type-2 Diabetes

3.31 Type-2 Diabetes and Erectile Dysfunction

3.32 “The Canary in the Coal Mine”

3.33 How Does Diabetes Lead to Erectile Dysfunction?

3.34 Cautionary Note

3.35 Caveat

References

Chapter 4. Oxidative Stress Damages the Endothelium

4.1 Introduction

4.2 Sources of Free Radicals

4.3 Reactive Oxygen Species and Antioxidants

4.4 Scavenging Antioxidants

4.5 Coenzyme Q10

4.6 Glutathione and Erectile Dysfunction

4.7 Preventive Antioxidants

4.8 Antioxidants—Caveat

4.9 Oxidative Stress

4.10 Age-Related Glutathione Activity Decline

4.11 Free Radical Endothelium Damage in Diabetes

4.12 Postprandial Oxidative Stress in Type-2 Diabetes

4.13 Fructose Reconsidered

4.14 Diabetes, Advanced Glycation End-Products, the Endothelium, and the Penis

4.15 Cooking Affects Advanced Glycation End-Products

4.16 Caveat

4.17 Oxidative Stress: Nemesis of the Endothelium

4.18 Is the Endothelium Seamless?

4.19 Fixing it with Antioxidants

4.20 When Even VIAGRA® Fails

4.21 Lifestyle Approach

4.22 Oxygen Radical Absorbance Capacity

4.23 Oxygen Radical Absorbance Capacity of Selected Foods, Release 2 (2010)

4.24 Inhibition Assay

4.25 How Advisable is Supplementing?

4.26 Is There an Age-Related Progressive Antioxidant Deficiency Syndrome?

4.27 Nature’s Antioxidant Response Element

References

Chapter 5. Metabolic Syndrome Impairs Erectile Function

5.1 Introduction

5.2 What is Metabolic Syndrome?

5.3 Metabolic Syndrome May Entail Cardio-Sexual Risk Equal to Diabetes and Coronary Heart Disease

5.4 Blame it on Diet

5.5 Note on Relevant Types of Diet

5.6 Standard American Diet

5.7 Prudent Diet

5.8 Metabolic Syndrome and Hypertension

5.9 Metabolic Syndrome Entails Increased Risk of Coronary Heart Disease and Stroke

5.10 Metabolic Syndrome and Atherosclerosis

5.11 Metabolic Syndrome and Almost-Atherosclerosis

5.12 Metabolic Syndrome and Heart Disease

5.13 Metabolic Syndrome, Obesity, Insulin Resistance, and Diabetes

5.14 Glucose Allostasis

5.15 Obesity, Leptin/Ghrelin, and the Link to Erectile Dysfunction

5.16 Eating, Energy Consumption and Storage

5.17 A Note on Leptin and Dopamine

5.18 Leptin Levels Tend to Rise with Age

5.19 Ghrelin

5.20 Ghrelin Levels Tend to Decline with Age

5.21 Leptin is Linked to Inflammation Markers

5.22 Leptin and Blood Pressure

5.23 Leptin Damages the Endothelium

5.24 Leptin and the Heart

5.25 Leptin Raises Fibrinogen, thus Promoting Hazard of Blood Clotting

5.26 Age-Related Leptin Resistance and Erectile Dysfunction

5.27 Age-Related Rise in Insulin Resistance

5.28 Metabolic Syndrome Impairs Endothelial Function

5.29 Metabolic Syndrome and Erectile Dysfunction

5.30 Testosterone Deficiency

5.31 Normal Testosterone Levels

5.32 Age-Related Testosterone Decline

5.33 Prevalence of Low Testosterone and Coronary Artery Disease

5.34 Prevalence of Low Testosterone and Metabolic Syndrome

5.35 Prevalence of Hypogonadism and Links to Hypertension, Atherosclerosis, and Diabetes

5.36 Low Testosterone Level is Linked to Type-2 Diabetes

5.37 Low Testosterone Compromises Endothelial Function

5.38 Diabetes and Testosterone Deficiency

References

Chapter 6. Asymmetric Dimethylarginine Impairs Nitric Oxide Bioavailability and Jeopardizes Cardio-Sexual Function

6.1 Introduction

6.2 Asymmetric Dimethylarginine Concentration is a Major Clue to Endothelial Viability

6.3 Asymmetric Dimethylarginine and Lipid Disorders

6.4 The Homocysteine–Asymmetric Dimethylarginine Link in Endothelial Dysfunction

6.5 Asymmetric Dimethylarginine and Hypertension

6.6 How Independent Is the Endothelium-Independent Vasodilation Pathway?

6.7 Endothelium-Derived Contracting Factor

6.8 Asymmetric Dimethylarginine in Type-2 Diabetes

6.9 Asymmetric Dimethylarginine and Erectile Dysfunction

6.10 The Asymmetric Dimethylarginine–L-Arginine Connection

References

Chapter 7. Arginine Supplementation in Cardiovascular Disorders

7.1 Introduction

7.2 Pharmacodynamics of L-arginine

7.3 Nitric Oxide-Dependent and -Independent Vascular Action of L-arginine

7.4 The 1992 Science “Molecule of the Year”

7.5 L-arginine—A Building Block of Protein

7.6 L-arginine Blood Cell Transport

7.7 Is Defective Transport a Possible Cause of Cardio-Sexual Impairment?

7.8 Endothelial Nitric Oxide from L-arginine—Nitric Oxide Synthase

7.9 L-arginine and Nitric Oxide Bioavailability in Aging

7.10 Cardio-Sexual Benefits of Oral L-arginine

7.11 The Arginine Paradox

7.12 Measuring Nitric Oxide Formation Directly after L-arginine Supplementation

7.13 L-arginine and Hypertension

7.14 Oral L-arginine Lowers Blood Pressure

7.15 Oral L-arginine Improves Damaged and Aging Endothelium

7.16 L-arginine, Insulin Resistance, and Type-2 Diabetes

7.17 Oxidative Stress and Metabolic Syndrome

7.18 Oral L-arginine Combats Atherosclerosis

7.19 Oral L-arginine and Heart Disease

7.20 Caveat

References

Chapter 8. Arginine and Arginine-Combinations in Treatment of Erectile Dysfunction

8.1 Introduction

8.2 Some Molecular Factors Affecting Nitric Oxide Biosynthesis

8.3 Vascular Erectile Dysfunction Cannot Be Caused by Insufficient L-Arginine

8.4 Supplements with L-Arginine in Treatment of Erectile Dysfunction

8.5 United States Government Supplements Regulations and Safety Information

8.6 L-Arginine Dietary Supplements to Support Erectile Vitality

8.7 L-Arginine Supplementation in a Fruit Bar

8.8 L-Citrulline—Supplementation Raises L-Arginine Levels

8.9 L-Arginine Oral Supplements—Nutraceutical Approach to Support Erectile Function

8.10 L-Arginine and Yohimbe/Yohimbine

8.11 Cautionary Note

8.12 L-Arginine and Pycnogenol®

8.13 Caveat: Mayo Clinic Cautions

Notes

References

Chapter 9. The Polyphenolic Antioxidant Resveratrol, the Carotinoid Lycopene, and the Proanthocyanidin Pycnogenol

9.1 Introduction

9.2 Resveratrol

9.3 Lycopene

9.4 Pycnogenol

References

Chapter 10. Selected Micronutrients and the Metabolic Basis for Their Support of Endothelial Health and Erectile Function

10.1 Introduction

10.2 Chromium Reduces Insulin Resistance in Type-2 Diabetes

10.3 Cinnamon—Clinical and Research Data on Benefits in Type-2 Diabetes

10.4 The Homocysteine, Atherosclerosis, and Vitamin Conundrum

10.5 Niacin (Vitamin B₃)

References

Index