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Potential predictors of asymptomatic ischemic heart disease in patients with vasculogenic erectile dysfunction
1Department of Urology, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
Insights
Cardiovascular risk factors predict asymptomatic ischemic heart disease in men with erectile dysfunction. Nonresponders over 55 with hypertension need cardiac evaluation before medication.
Area of Science:
- Cardiology
- Urology
- Preventive Medicine
Background:
- Vasculogenic erectile dysfunction (VED) often coexists with cardiovascular disease.
- Identifying asymptomatic ischemic heart disease (IHD) in VED patients is crucial for proactive management.
- Most VED patients present with at least one cardiovascular risk factor.
Purpose of the Study:
- To identify predictors of asymptomatic IHD in patients with VED.
- To establish a practical method for assessing IHD risk in this population.
Main Methods:
- Prospective study of 97 men >45 years with VED and no prior IHD history.
- Patients categorized into responders and nonresponders based on pharmacologic erection tests.
- Cardiologic evaluation included risk factor assessment, physical exam, and exercise treadmill test.
Main Results:
- Nonresponders showed a trend towards more cardiovascular risk factors (49.0% vs 32.6%).
- Ischemic ST-segment changes on treadmill tests were significantly more frequent in nonresponders (15.7%, P=0.006).
- All nonresponders with ischemic changes were >55 years and had multiple risk factors, including hypertension.
Conclusions:
- Asymptomatic IHD may be predicted in VED patients.
- Nonresponders to pharmacologic erection tests, aged over 55, with multiple risk factors (including hypertension) warrant cardiac evaluation.
- These findings support targeted cardiovascular assessment before prescribing medications like sildenafil.
Objectives:
To prospectively define the potential predictors of asymptomatic ischemic heart disease in patients with vasculogenic erectile dysfunction using a simple and practical method. Most patients with vasculogenic erectile dysfunction are known to have at least one significant cardiovascular risk factor.
Methods:
After baseline evaluations, patients with erectile dysfunction of presumed vascular origin, who were older than 45 years and with no history of ischemic heart disease, were enrolled in the study. According to the results of repeated pharmacologic erection tests, we divided patients into responders and nonresponders. The cardiologic evaluations consisted of a comprehensive history taking, the assessment of cardiovascular risk factors, a physical examination, and an exercise treadmill test.
Results:
A total of 97 patients completed the study. Fifteen (32.6%) of 46 responders and 25 (49.0%) of 51 nonresponders, respectively, had two or more cardiovascular risk factors (P = 0.101). Ischemic ST-segment changes on the exercise treadmill test were only observed in 8 nonresponders (15.7%) (P = 0.006). All these patients were older than 55 years, and seven had two or more cardiovascular risk factors, including hypertension.
Conclusions:
On the basis of these preliminary data, we suggest that cardiovascular evaluations may prove beneficial before prescribing sildenafil to patients with vasculogenic erectile dysfunction who are nonresponders to the pharmacologic erection test, are older than 55 years, and have two or more risk factors, including hypertension.