Erectile dysfunction and silent coronary artery disease: abnormal computed tomography coronary angiogram in the
1Cardiothoracic Centre, Guy's & St Thomas' NHS Hospital Trust, St Thomas' Hospital, London, UK. gjcardiol@talk21.com
Insights
Erectile dysfunction (ED) may predict early coronary artery disease (CAD) undetectable by standard exercise tests. Men with ED and no cardiac symptoms should receive aggressive cardiovascular risk reduction therapy.
Area of Science:
- Cardiology
- Urology
- Radiology
Background:
- Erectile dysfunction (ED) and coronary artery disease (CAD) frequently coexist, with ED often preceding cardiac events by 3-5 years.
- Exercise electrocardiography can detect flow-limiting CAD, while cardiac computed tomography (CT) can identify vulnerable, non-calcified plaques.
- ED may serve as an early indicator of subclinical cardiovascular disease.
Purpose of the Study:
- To investigate the utility of cardiac CT angiography in detecting subclinical coronary artery disease (CAD) in men with erectile dysfunction (ED) and no cardiac symptoms.
- To compare the diagnostic capabilities of exercise electrocardiography and cardiac CT in identifying early-stage CAD in this population.
Main Methods:
- Twenty men (aged 39-69) with ED and no cardiac symptoms underwent cardiovascular risk screening.
- Screening included maximal treadmill exercise testing and CT coronary angiography.
- Erectile dysfunction was confirmed using the Sexual Health Inventory for Men questionnaire.
Main Results:
- Eighteen participants had elevated low-density lipoprotein cholesterol; none were diabetic, and seven had controlled hypertension.
- Eleven men (73%) had coronary calcium scores > 50, indicating significant CAD on CT angiography.
- Nine of these men with high calcium scores had normal exercise ECG results, highlighting the limitations of exercise testing.
- Four men had mild CAD (calcium scores 6-17), and five had normal cardiac CT findings.
Conclusions:
- Erectile dysfunction may be a predictor of subclinical, non-flow limiting CAD not detected by exercise electrocardiography.
- Men diagnosed with organic ED and lacking cardiac symptoms should be considered 'cardiac equivalents'.
- Aggressive cardiovascular risk reduction therapy is recommended for men with ED and no apparent cardiac disease.
Background:
Erectile dysfunction (ED) and coronary artery disease (CAD) frequently coexist. ED may be present in the absence of cardiac symptoms 3-5 years before a coronary event. Exercise electrocardiography may identify flow-limiting CAD but cardiac computed tomography (CT) may identify early non-calcified plaque disease potentially vulnerable to rupture precipitating an acute event.
Methods:
Twenty men aged 39-69 years with ED and no cardiac symptoms underwent screening for cardiovascular risk including maximal treadmill exercise testing and CT coronary angiography. ED was confirmed using the Sexual Health Inventory for Men questionnaire.
Findings:
Eighteen had a low-density lipoprotein cholesterol > 3 mmol/l, none were diabetic and seven were hypertensive controlled on medical therapy. Coronary calcium scores were > 50 in 11 men (range: 54-1234) all of whom had angiographic CAD on CT. Nine of these had normal exercise ECGs. Four men had calcium scores of 6-17 and single plaque disease on CT. Five had normal cardiac CT studies.
Interpretation:
Erectile dysfunction may be a predictor of subclinical non-flow limiting CAD not detectable on exercise electrocardiography. Men with organic ED and no cardiac symptoms should be considered as 'cardiac equivalents' and aggressive risk reduction therapy initiated.
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