Relationship Between Erectile Dysfunction and Silent Myocardial Ischemia in Apparently Uncomplicated Type 2 Diabetic Patients

Abstract

Background-Erectile dysfunction (ED) is associated with coronary artery disease (CAD). In diabetic patients, CAD is often silent. Among diabetic patients with silent CAD, the prevalence of ED has never been evaluated. We investigated whether ED is associated with asymptomatic CAD in type 2 diabetic patients. Methods and Results-We evaluated the prevalence of ED in 133 uncomplicated diabetic men with angiographically verified silent CAD and in 127 diabetic men without myocardial ischemia at exercise ECG, 48-hour ambulatory ECG, and stress echocardiography. The groups were comparable for age and diabetes duration. Patients were screened for ED using the validated International Index of Erectile Function (IIEF-5) questionnaire. The prevalence of ED was significantly higher in patients with than in those without silent CAD (33.8% versus 4.7%; Pϭ0.000). Multiple logistic regression analysis showed that ED, apolipoprotein(a) polymorphism, smoking, microalbuminuria, HDL, and LDL were significantly associated with silent CAD; among these risk factors, ED appeared to be the most efficient predictor of silent CAD (OR, 14.8; 95% CI, 3.8 to 56.9). Conclusions-Our study first shows a strong and independent association between ED and silent CAD in apparently uncomplicated type 2 diabetic patients. If our findings are confirmed, ED may become a potential marker to identify diabetic patients to screen for silent CAD. Moreover, the high prevalence of ED among diabetics with silent CAD suggests the need to perform an exercise ECG before starting a treatment for ED, especially in patients with additional cardiovascular risk factors.

Comparison between primary angioplasty and thrombolytic therapy on erectile dysfunction after acute ST elevation myocardial infarction

“…15 Silent ischemia and ED are also known to occur in patients with uncomplicated diabetes. 16 These findings support the idea that ED and CAD share similar pathophysiological mechanisms and form a dangerous cycle.…”

“…There is an association between the severity of CAD and ED. [12][13][14][15][16] Many researchers have reported that ED manifests approximately 24-36 months before the manifestation of CAD. 12 Previous studies reported that the existence ED is associated with a twofold increase in the risk of STEMI among men.…”

“…12 Previous studies reported that the existence ED is associated with a twofold increase in the risk of STEMI among men. [14][15][16] Ortiz et al 15 reported that the incidence of sexual dysfunction after STEMI ranges from 50% to 75% of all patients and is often present before the cardiac event. In the presence of many risk factors, atherosclerosis affects the endothelium of the arteries.…”

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

“…16,17 Erectile dysfunction commonly occurs in the presence of silent CAD, 3,[18][19][20] with a time window between ED onset and a CAD event of 2 to 5 years (class Ia). 3,4,21 Furthermore, evidence suggests that ED is predictive of peripheral arterial disease (PAD) 22 and stroke.…”

“…In a study of patients with type 2 diabetes, ED was significantly more prevalent in men with silent CAD (33.8%) identified by EST than in those without silent CAD (4.7%). 18 Chemical stress tests (dipyridamole [Persantine, Boehringer Ingellheim GmbH, Ingelheim, Germany] or adenosine with nuclear imaging) are appropriate for patients who cannot complete an EST (eg, inability to exercise due to a disabling condition such as arthritis). If the baseline electrocardiogram makes EST unavailable or noninterpretable, the consensus panel recommends refer-ral to a cardiologist or a practice with cardiology expertise for further evaluation.…”