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Lining the inner walls of blood vessels is a thin layer of cells known as the endothelium. Keeping the endothelium healthy helps to promote robust blood flow, thus supporting normal erectile function.
The endothelium is a thin layer of cells that lines the inside surfaces of blood vessels and lymphatic vessels, a sort of living “wallpaper” that provides an interface between circulating blood or lymph and the vessel wall through which it is flowing. Vascular endothelial cells line the circulatory system, right down to the tiniest capillaries. In an adult human, the body’s endothelial cells weigh about 2.2 pounds, and if they were spread out on a flat surface they would cover anywhere from 11 to 75 square feet. They don’t simply line blood and lymphatic vessels passively but have several functions related to keeping the circulatory system healthy.
Functions of Endothelial Cells
In terms of vascular function, endothelial cells contribute significantly. For one thing, they form a semiselective barrier between the interior of the blood or lymph vessel and the surrounding tissue so that products like white blood cells can enter and exit the bloodstream where they’re needed. Normal endothelial tissue creates a nonthrombogenic (non-clot-facilitating) surface, and it plays a role in both inflammation and new blood vessel formation.
Because endothelial cells help control constriction or dilation of blood vessels, they aid in the control of blood pressure. Furthermore, they assist with repair of diseased or damaged organs by injection of certain types of cells. In short, these versatile, “gatekeeper” cells are important in keeping people healthy.
Endothelial Dysfunction and the Heart
When endothelial cells don’t work properly, vascular (heart) disease is often the result. In fact, problems with endothelial cells are considered a key “early event” in the progression of heart disease. When the endothelium doesn’t work properly, results can include high blood pressure and thrombosis (clot formation). Poor endothelial function is often seen in people who have diabetes and high cholesterol, as well as in people who smoke.
The clinical association between endothelial cell dysfunction and cardiac issues has been well established — and these are major cardiovascular events like cardiac death, heart attack, and the need for bypass surgery. What’s more, endothelial dysfunction may or may not be accompanied by the “traditional” risk factors for heart disease, which means it may be a very sensitive indicator of cardiovascular health.
Healthy Endothelium and Blood Flow
A healthy endothelium regulates blood flow throughout the body, including to the sex organs. When endothelial cells are functioning properly, they create an “antithrombotic” surface (antagonistic to the formation of clots) that ensures smooth transit of blood throughout the vascular system. The endothelium also regulates vascular function via secretion and uptake of various substances that cause constriction and dilation of blood vessels in response to various stimuli. Sexual stimulation is one example of a stimulus.
In men with erectile dysfunction, endothelial function is often less than optimal, which means that erection health can be an indicator of potentially wide-ranging problems with the circulatory system. The good news is that ED is often one of the earliest indicators of trouble, and addressing ED through prescription medications and lifestyle changes can prevent vascular issues from worsening.
Production of Nitric Oxide
The endothelium continuously makes nitric oxide, which has many biological properties having to do with maintaining the vascular system. For example, nitric oxide modulates dilation of blood vessels, and protects them from injury from circulating platelets and other cells. Diminished release of nitric oxide into arterial walls (either due to lower synthesis of it or faster degradation of it) is considered a risk factor for heart disease, high blood pressure, and high cholesterol.
Lower nitric oxide activity can result in constriction of coronary arteries during physical or mental stress. Low levels of nitric oxide can also lead to vascular inflammation, which is a precursor to the fatty plaques that form along artery walls with heart disease. Nitric oxide is also important in how prescription ED medications like Viagra work.
How Viagra Affects Nitric Oxide
Nitric oxide is important in the signaling pathways that lead to erections. It is able to pass through cell membranes without dedicated “transporter” molecules because it is a gas. Supplied by two sources (one a neurotransmitter excreted by the cavernous nerve and the other being the endothelial cells lining the deep arteries of the penis), nitric oxide acts as a vasodilator, causing blood vessels to expand.
Drugs like Viagra result in higher levels of a substance called cyclic guanosine monophosphate, or cGMP, which ultimately results in the relaxation of smooth muscle cells of the blood vessels, which causes the vessels to dilate and results in an erection in the presence of sexual stimulation. Viagra and its competitors are known as PDE5 inhibitors because they block the phosphodiesterase-5 enzyme, which normally breaks down cGMP. More cGMP means easier dilation of blood vessels in the penis.
Link Between ED, Heart Health
When the endothelium is healthy, it produces nitric oxide so the vascular system has an easier time resisting plaque, clot formation, or artery constriction. Healthy endothelium also means healthier, stronger erections. Likewise, unhealthy endothelium tends to show up as weaker erections and eventually erectile dysfunction. This is an indication of poor blood flow response throughout the body, including to the heart, and an increasing number of doctors consider ED a possible early indicator of cardiac issues.
Men under age 50 without known heart disease, but with ED, can have an up to 50-fold higher incidence of heart events compared with the same-age men without ED. That’s an enormously powerful risk factor. Smoking only causes a threefold increase in the risk of heart events. It’s no mystery why so many doctors consider ED a “canary in the coalmine” predictor of future heart problems.
How to Care for Your Endothelium
Caring for your endothelium means caring for overall physical and mental health. The typical American diet is too high in calories, sugar, salt, and fat to maintain healthy endothelium indefinitely. Eating right, which means consuming a wide variety of fruits and vegetables, whole grains, and lean protein while keeping sugar and salt consumption down, is one way to ensure the endothelium has what it needs to do its work properly.
Smoking is another habit that’s detrimental to the endothelium, and it’s also associated with a higher risk of ED. Regular physical exercise, on the other hand, improves circulation and stamina and helps the endothelium work as it should. Taking a medication like Viagra for ED isn’t enough to heal an unhealthy endothelium, however. That’s another reason why doctors encourage men with ED to adopt healthier lifestyle habits along with the medications they take for the condition.
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