Elsevier

European Urology

Volume 44, Issue 3, September 2003, Pages 360-365
European Urology

Erectile Dysfunction Prevalence, Time of Onset and Association with Risk Factors in 300 Consecutive Patients with Acute Chest Pain and Angiographically Documented Coronary Artery Disease

https://doi.org/10.1016/S0302-2838(03)00305-1Get rights and content

Abstract

Objectives: The aim of this study was to assess erectile dysfunction prevalence, time of onset and association with risk factors in patients with acute chest pain and angiographically documented coronary artery disease.

Methods: 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease were assessed using a semi-structured interview investigating their medical and sexual histories, the International Index of Erectile Function and other instruments.

Results: Patient mean age was 62.5±8 years (range 33–86 years). Mean duration of symptoms or signs of myocardial ischaemia prior to enrolment in the study was 49 months (range 1–200). Coronary angiography showed 1-, 2- and 3-vessel disease in 98 (32.6%), 88 (29.3%) and 114 (38%) patients, respectively. The prevalence of ED among all patients was 49% (147/300). Erectile dysfunction was scored as mild, mild to moderate, moderate and severe in 21 (14%), 31 (21%), 20 (14%), and 75 (51%) of patients, respectively. There was no significant difference between patients with ED (n=147) or without ED (n=153) as far as clinical and angiographic characteristics were concerned.

In the 147 patients with co-existing ED and CAD, ED symptoms were reported as having become clinically evident prior to CAD symptoms by 99/147 (67%) patients. The mean time interval between the onset of ED and CAD was 38.8 months (range 1–168). There was no significant difference in terms of risk factor distribution and clinical and angiographic characteristics between patients with the onset of ED before vs. after CAD diagnosis. Interestingly, all patients with type I diabetes and ED actually developed sexual dysfunction before CAD onset (p<0.001).

Conclusions: Our study suggests that a significant proportion of patients with angiographically documented coronary artery disease have erectile dysfunction and that this latter condition may become evident prior to angina symptoms in almost 70% of cases. Future studies including a control group of patients with coronary artery disease and normal erectile function are required in order to verify whether erectile dysfunction may be considered a real predictor of ischemic heart disease.

Introduction

Erectile dysfunction (ED) is defined as the recurrent or persistent inability to achieve and/or maintain an erection in order for satisfactory intercourse to occur. The reported prevalence of ED in the general population ranges from 19% to 52% [1], [2]; this span is likely due to differences in the criteria used in defining ED and to the lack of systematic stratification by age. Despite this significant difference in ED prevalence, the age-related increase of ED and the correlation between ED and vascular risk factors—hypertension, hypercholsterolemia, cigarette smoking, diabetes and obesity—are common findings of several studies [1], [2], [3], [4], [5], [6]. These data suggest that ED may be considered a clinical manifestation of a functional (i.e. endothelial dysfunction) and/or a structural abnormality affecting penile circulation as a part of a more generalized vascular disorder [7], [8]. So far, little is known about the predictive role of ED as a marker of sub-clinical coronary artery disease (CAD). The aim of this prospective study was to evaluate patients presenting acute coronary syndromes (ACS) in our emergency units—and subsequently diagnosed with documented CAD—in terms of ED prevalence and its chronological and aetiological correlations with heart disease.

Section snippets

Material and methods

In two emergency units, between February 2001 and July 2002, we prospectively evaluated 340 consecutive patients (mean age 62.5±8 years; range 33–86) with ACS who subsequently underwent coronary angiography. Both those patients presenting with a first angina episode and those with a known history of CAD underwent full cardiological assessments. For the purpose of this study, the only additional inclusion criterion was the detection (by coronary angiography) of a significant stenosis (>50%

Results

Twenty-seven out of 340 (12%) successive patients refused to enter the study and did not sign the informed consent. Thirteen out of the 313 remaining patients (4%) were excluded from the study due to unsatisfactory completion of the self-administered questionnaires. Three hundred patients completed the study protocol and were included in the data analysis. The clinical characteristics of the patient population are reported in Table 1.

Patient mean age was 62.5±8 years (range 33–86 years). The

Discussion

Evidence is accumulating in favor of considering ED as a vascular disorder [12], [13]. Common risk factors for atherosclerosis have been frequently found in patients with ED; in addition, the extent of ED has been related to the number and severity of vascular risk factors [13], [14]. Moreover, abnormal sexual function has been reported in patients with vascular diseases such as myocardial infarction, cerebrovascular accidents, hypertension and peripheral arterial disease [5]. Little is known,

Acknowledgments

The authors are grateful to Prof. Carey Berniz for reviewing the linguistic style of this manuscript. The study was supported by an unrestricted research grant by Pfizer Italia.

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