Vasculogenic ED

ED is predominantly a vascular disease. Vasculogenic ED is characterized by decreased production of vasorelaxant messengers, increased vasoconstriction, and reduced vasodilatory responses of smooth muscle cells [13]. The major mechanisms underlying vasculogenic ED are reduced endothelial NO bioavailability and increased oxidative stress. A variety of conditions that involve vascular abnormalities, such as diabetes, aging, hypercholesterolemia, hypertension, hyperhomo-cysteinemia, sedentary lifestyle, sickle cell disease (SCD), and cigarette smoking, are associated with the impairment of penile vascular function and vasculogenic ED in men and in a number of animal models ([13]; see Fig. 28.2). An early stage of vascular damage is represented by endothelial dysfunction, which can lead to increasingly severe changes such as atherosclerosis in the systemic vasculature and manifests clinically as coronary, renal, cerebral, and peripheral artery diseases. In fact, vasculogenic ED is a silent marker for cardiovascular and other systemic vascular diseases and carries an independent risk for future cardiovascular events [14],

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