Erectile Dysfunction May Be Earliest Warning of Heart Disease

MILAN, July 19 -- Erectile dysfunction may be masking latent ischemic heart disease, according to researchers here.

In a study of almost 300 men with coronary artery disease, erectile dysfunction was seen to appear two to three years before coronary symptoms, reported Piero Montorsi, M.D., and colleagues, of the University of Milan online in the European Heart Journal.

And while erectile dysfunction is closely associated with coronary artery disease, it is more common among patients with chronic versus acute coronary syndrome, they wrote.

Erectile dysfunction appeared to correlate with severity of coronary artery disease. It was significantly less prevalent among men with single-vessel acute coronary syndrome than it was among men with two- or three-vessel disease acute coronary syndrome or patients with chronic coronary syndrome (22% versus 55% and 65% P<0.0001). It also correlated with plaque burden as assessed by angiography and measured by Gensini score (two in patients with single-vessel disease versus 21 in patients with two- or three-vessel disease and 40 in those with chronic coronary disease, P=0.0001).

Moreover, erectile dysfunction symptoms came prior to coronary artery disease symptoms in virtually all patients, appearing a mean three years earlier, they wrote.

Patients and controls were recruited from a population of 3,300 patients who underwent coronary angiography from May 2004 through July 2005.

The authors categorized the 285 patients with established coronary artery disease into three groups of 95 each. These were patients with acute coronary syndrome and single-vessel disease, patients with acute coronary syndrome and two- or three-vessel disease, and patients with chronic coronary syndrome regardless of the number of vessels. The groups were compared to a control group of 95 patients with suspected coronary artery disease who had completely normal vessels by angiography.

Erectile dysfunction was evaluated using the International Index of Erectile Dysfunction, a-15-item self-administered questionnaire with answers scored 0 to 5. Erectile dysfunction is defined as a score of less than 26.

Among the findings:

• Overall the erectile dysfunction prevalence in patients was 47% (135 of 285).
• Among controls erectile dysfunction prevalence was 24% (23 of 95).
• Severe erectile dysfunction, defined as an International Index of Erectile Dysfunction score of less than 10, was present in 26% of patients, but was significantly more common among men with two- and three-vessel diseases than among men with single vessel disease (31% versus 12.5%, P<0.01).

Patients did not undergo anatomical and function evaluation of penile circulation, and the authors cited that as a limitation. Additionally, although coronary angiography is considered the gold standard for detection of coronary artery disease, the authors noted that that it detects only lumen artery change and not true plaque volume extension, which is another limitation, they wrote.

Graham Jackson, M.D., of Guy's and St. Thomas NHS Trust in London wrote in an accompanying editorial that the study adds to the body of knowledge linking erectile dysfunction and atherosclerosis.

"All men with [erectile dysfunction] and no cardiac symptoms need a detailed cardiac assessment, measurement of blood pressure, fasting lipid profile and glucose, as well as lifestyle advice regarding weight and exercise," Dr. Jackson wrote.

The of erectile dysfunction of an early warning report for ischemic heart disease follows a similar one in the Dec. 21 issue of the Journal of the American Medical Association by Ian Thompson, M.D., of the University of Texas Health Science Center in San Antonio.