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Published on: February 3, 2021
Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective
Charalambos Vlachopoulos1, Konstantinos Rokkas, Nikolaos Ioakeimidis
1Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece. cvlachop@otenet.gr
Insights
Erectile dysfunction (ED) in men may indicate silent coronary artery disease (CAD). Many men with ED have multiple risk factors and require further cardiovascular evaluation to detect underlying vascular disease.
Area of Science:
- Cardiology
- Vascular Medicine
- Urology
Background:
- Erectile dysfunction (ED) shares risk factors with coronary artery disease (CAD).
- ED may represent generalized vascular disease affecting penile arteries.
- Prospective evaluation of asymptomatic men with ED for CAD is warranted.
Purpose of the Study:
- To assess the incidence of asymptomatic coronary artery disease (CAD) in men with erectile dysfunction (ED) of vascular origin.
- To evaluate the severity of CAD using coronary arteriography.
Main Methods:
- Fifty men (aged 41-74) with non-psychogenic, non-hormonal ED underwent medical history, examination, exercise treadmill test, and stress echocardiography.
- Patients with positive non-invasive tests were referred for coronary arteriography.
- Coronary arteriography documented CAD and its severity.
Main Results:
- Common risk factors in ED patients included smoking (64%), hypertension (62%), and hyperlipidemia (52%).
- 70% of patients had two or more cardiovascular risk factors.
- 19% (9/47) of men with ED had angiographically confirmed silent CAD, including single, double, and triple-vessel disease.
Conclusions:
- A significant proportion of men with ED of vascular origin have silent CAD.
- These findings support cardiovascular screening for patients presenting with ED.
- ED can be an early indicator of underlying systemic vascular disease.
Objectives:
Erectile dysfunction (ED) shares common risk factors with coronary artery disease (CAD). It has been suggested that ED may be considered a clinical manifestation of a generalized vascular disease affecting also the penile arteries. The aim of this prospective study was to evaluate angiographically the incidence of asymptomatic CAD in men with ED of vascular origin.
Methods:
Fifty consecutive asymptomatic men, aged 41-74 years, with non-psychogenic and non-hormonal ED were comprehensively evaluated using medical history and examination, exercise treadmill test and stress echocardiography. Patients who had positive one or both of the two non-invasive procedures were referred for coronary arteriography in order to document CAD and evaluate the severity of the disease.
Results:
The mean time interval between the onset of ED and cardiological assessment was 25 months (range 1-66). Smoking (32 patients/64%), hypertension (31 patients/62%) and hyperlipidemia (26 patients/52%) were the most common risk factors. Moreover, 35 men (70%) had two or more risk factors. Twelve patients (24%) with ED had positive one or both of the two non-invasive procedures and one patient presented with acute myocardial infarction before he completed the non-invasive investigation. Coronary arteriography performed in ten patients (in nine with positive one or both of the two non-invasive procedures [while the other three refused], and in the patient with acute myocardial infarction) demonstrated that one patient had three-vessel disease, two patients had two-vessel disease and six patients had single-vessel disease.
Conclusions:
A considerable proportion (9/47 or 19%) of patients with ED of vascular origin has angiographically documented silent CAD. These findings support the strategy that patients with ED should undergo further cardiovascular evaluation.
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