Imaging penile arteries using a bone-seeking radiopharmaceutical enabled investigators for the first time to demonstrate a link between atherosclerosis and erectile dysfunction (ED), according to a new report.

“The study demonstrates atherosclerosis to be the basis of ED,” said investigator Jagat Narula, MD, PhD, professor of cardiology and radiology at the Icahn School of Medicine at Mount Sinai in New York, said in a press release. “Since all patients in the study had prostate cancer, a prospective study will need to be done in normal population with ED for conclusive results.”

Investigators performed whole-body positron emission tomography-computed tomography (PET-CT) on 437 patients with prostate cancer approximately 70 minutes following intravenous injection of fluorine-18 sodium fluoride (18F-NaF), which is known to localized in focal areas of active microcalcification in atheromatous plaques, Dr Narula and colleagues explained. The investigators hypothesized that NaF uptake in penile vessels could serve as a marker of vasculogenic ED. The hypothesis is based on the researchers’ previous review of bone scans in which they frequently noted NaF uptake in penile arteries.

The investigators found an incidental uptake of NaF in penile arteries, suggesting the presence of atherosclerosis. Of 437 patients, 77% had prevalent ED, and ED developed in 13% within the next year. Each 0.5-unit increment in fluoride uptake was significantly associated with 25-fold increased odds of prevalent or Incident ED, after adjusting for other risk factors, investigators reported in the Journal of the American College of Cardiology.

The study population had a mean age of 66.6 years. Of the 437 men, 244 (56%) had hypertension, 247 (57%) had dyslipidemia, and 70 (16%) had type 2 diabetes. In addition, 204 (47%) had a history of smoking and 52 (12%) had a history of coronary artery disease.

The investigators called their findings “intriguing and provocative,” but noted that the study had limitations, including the retrospective design and enrollment of patients from a single tertiary care referral center. In addition, the authors pointed out that most men did not have lipid profiles, so they could not calculate Framingham Risk Scores to evaluate the relationship between risk factors and possible penile artery atherosclerosis.

Reference

Nakaharea T, Narula J, Tijssen JGP, et al. 18F-fluoride positron emission tomographic imaging of penile arteries in men with erectile dysfunction. J Am Coll Cardiol. 2019; published online ahead of print.

http://www.onlinejacc.org/content/early/2019/02/07/j.jacc.2018.10.076