An Italian study of men with erectile dysfunction ( ED ) and coronary artery disease ( CAD ) has shown for the first time that the rates of dysfunction differ according to the type and severity of the disease.

It is low among men who have acute coronary syndrome ( ACS ), mainly acute myocardial infarction with one blood vessel affected, but high in those with chronic coronary syndrome ( CCS ), mainly effort-induced angina pectoris and involving many arteries narrowed by atherosclerosis.

They have also shown in their study of nearly 300 men, that among patients with chronic coronary syndrome who had both ED and CAD, 93% reported symptoms of erectile dysfunction between one and three years before experiencing angina, with two years being the average time.

The results have prompted the researchers, from the University of Milan and the University Vita-Salute Ospedale S. Raffaele, also in Milan, to call for long-term medical surveillance in patients with erectile dysfunction and multiple risk factors, but with no clinical signs of coronary artery disease. They say their research has fuelled the concept of erectile dysfunction as ‘sentinel of the heart’.

Their warning has been reinforced in an accompanying editorial by Graham Jackson, at the Cardiothoracic Centre at Guy’s and St Thomas’ NHS Foundation Trust in London, UK.

“ All men with erectile dysfunction and no cardiac symptoms need a detailed cardiac assessment, blood pressure measurement, fasting lipid profile and glucose, as well as lifestyle advice regarding weight and exercise,” said Jackson. “ Those at cardiovascular risk ideally need stress testing and referral for risk reduction therapy, and advice with appropriate follow-up.”

Lead author of the study Piero Montorsi, at the Institute of Cardiology, University of Milan, explained that the study on 285 patients with coronary artery disease divided them into equal age-matched groups of 95:

a) those with ACS and disease in one vessel ( group 1 );

b) those with ACS and disease in two or three vessels ( group 2 );

c) those with CCS ( group 3 ).

A fourth ( control ) group, also of 95, of patients with suspected coronary artery disease but who were found by angiography to have normal coronary arteries.

“ In group 1 we found just over a fifth had erectile dysfunction compared to nearly two-thirds in group 3 ( 22% versus 65% ) and the control group had an erectile dysfunction rate similar to group 1 ( 24% ). Group 2’s erectile dysfunction rate was significantly different from group 1 with over half ( 55% ) having erectile dysfunction. In fact, it was similar to group 3, which suggests that despite the two ACS groups having a similar clinical presentation the erectile dysfunction rate in acute coronary syndrome differs according to the extent of the coronary artery disease. So, if more than one vessel is affected in those with acute coronary syndrome, their rate of erectile dysfunction is actually more like that of men with chronic coronary syndrome.”

Montorsi said: “Age, multi-vessel coronary involvement, and CCS, were independent predictors of erectile dysfunction. Conversely, we were able to evaluate whether erectile dysfunction could predict coronary artery involvement in acute coronary syndrome and found it was associated with a four-fold risk of having multi-vessel disease as opposed to single vessel disease, independently of other conventional risk factors. In other words, patients admitted to the hospital because of acute myocardial infarction who were found to have erectile dysfunction ( a few simple questions by the doctor are enough to make a correct diagnosis ) do have a four times increased risk of diffuse coronary artery disease. This information might be useful to guide the diagnostic and therapeutic approach.”

Although the study did not address whether men with erectile dysfunction but no other symptoms were at higher risk of future ACS or CCS as compared to those without erectile dysfunction, Montorsi said the risk of cardiovascular events in each patient with erectile dysfunction but no cardiovascular symptoms should be assessed and they should be treated as necessary. “ While waiting for further prospective, long-term studies, a strict medical surveillance programme should be mandatory in patients with erectile dysfunction, multiple risk factors and no clinical coronary artery disease.”

Jackson said that with an average two to three-year lead-time between erectile dysfunction and silent coronary artery disease becoming symptomatic there was potentially time to prevent cardiac events occurring.

Source: European Heart Journal, 2006


XagenaMedicine2006