Relation Between Erectile Dysfunction and Silent Myocardial Ischemia in Diabetic Patients: A Multidetector Computed Tomographic Coronary Angiographic Study

Abstract

IntroductionErectile dysfunction (ED) can precede coronary artery disease. In addition, silent myocardial ischemia (SMI) is more common in diabetic patients and is a strong predictor of cardiac events and death.AimTo evaluate the presence of SMI in patients with diabetes and ED using multidetector computed tomographic coronary angiography (MDCT-CA).MethodsThis study evaluated patients with diabetes and ED without any history of cardiac symptoms or signs. Erectile function was evaluated with the Sexual Health Inventory for Men score, erection hardness score (EHS), and maximal penile circumferential change by an erectometer. MDCT-CA was used for the detection of coronary artery stenosis.Main Outcome MeasuresSexual Health Inventory for Men score, EHS, maximal penile circumferential change, and coronary artery stenosis by MDCT-CA.ResultsOf 20 patients (mean age = 61.45 ± 10.7 years), MDCT-CA showed coronary artery stenosis in 13 (65%) in the form of one-vessel disease (n = 6, 30%), two-vessel disease (n = 2, 10%), and three-vessel disease (n = 5, 25%). Fifty percent of patients showed at least 50% vessel lumen obstruction of the left anterior descending coronary artery, which was the most commonly affected vessel (55%). Fifteen percent (3 of 20) of patients had greater than 90% stenosis, and two of them underwent an immediate coronary angioplasty with stenting to prevent myocardial infarction. Maximum coronary artery stenosis was positively correlated with age (P = 0.016, r = 0.529) and negatively correlated with EHS (P = .046, r = −0.449). Multivariate regression analysis using age and EHS showed that age was the only independent predictor of SMI (P = .04).ConclusionMDCT-CA can be a useful tool to identify SMI in diabetic patients with ED, especially in those of advanced age and/or with severe ED.

Erectile dysfunction and diabetes: A melting pot of circumstances and treatments

“…The main complications and comorbidities related to ED are schematically presented in Figure 1 and are discussed below. 17 …”

Silent coronary artery disease in type 2 diabetes: a narrative review on epidemiology, risk factors, and clinical studies

“…Peripheral vascular disease has been shown to be independently associated with silent CAD in several studies [11,39,45,108,110,111]. Rajagopalan et al [39] concluded that ECG Q waves, and peripheral artery disease (OR 2.134, CI 1.150-3.961; P = 0.016) were the 2 most important variables associated with high risk findings on stress SPECT, in their analysis.…”

“…The presence of diabetes target organ damage has been investigated in several studies, and a higher prevalence of silent CAD was demonstrated for retinopathy [20,26,55,93,94], neuropathy [11,[95][96][97][98][99][100], and nephropathy [59,[101][102][103][104], as well as for peripheral vascular disease [105][106][107][108][109][110][111][112].…”

“…Pathophysiological mechanisms common to CAD and erectile dysfunction involve abnormalities found in both vessels and nerves, and are ascribable to endothelial dysfunction, a decrease of nitric oxide-induced vasodilation and smooth muscle relaxation, and to diabetic autonomic neuropathy [96,113]. T2DM with erectile dysfunction show a higher prevalence of silent CAD [106,108], and the evaluation of erectile dysfunction in T2DM individuals has been suggested to be a powerful tool in improving the sensitivity of screening guidelines for SMI detection [109].…”