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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Subclinical Coronary Artery Atherosclerosis in Patients With Erectile Dysfunction

Emilio Chiurlia, PhD^_*,_*, Roberto D’Amico, MD, Carlo Ratti, MD^_*, Antonio R. Granata, MD, Renato Romagnoli, MD and Maria G. Modena, MD, FACC^_*

^_* Institute of Cardiology, University of Modena and Reggio Emilia, Modena, Italy
Unit of Statistics, University of Modena and Reggio Emilia, Modena, Italy
Department of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy
Institute of Radiology, University of Modena and Reggio Emilia, Modena, Italy

Manuscript received April 14, 2005; revised manuscript received June 10, 2005, accepted June 20, 2005.

^_* Reprint requests and correspondence: Dr. Emilio Chiurlia, Institute of Cardiology, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy. (Email: emiliochiurlia{at}virgilio.it).

OBJECTIVES: The purpose of our study was to assess the prevalence and extent of coronary artery atherosclerosis in asymptomatic patients with vascular erectile dysfunction (ED).

BACKGROUND: An association between ED and ischemic heart disease has been suggested, but it is unknown if it represents a marker of subclinical coronary atherosclerosis.

METHODS: We studied 70 consecutive patients with vascular ED, evaluated by penile Doppler, and 73 control subjects with no history of coronary artery disease. We measured traditional coronary risk factors, circulating levels of C-reactive protein (CRP), endothelial function by ultrasound of brachial artery, and coronary artery calcification by multi-slice computed tomography.

RESULTS: The patients and the control group were similar for age, race, and coronary risk score. Patients with ED had significantly higher high-sensitivity C-reactive protein levels (2.62 vs. 1.03 mg/l, p < 0.001). Flow-mediated dilation of the brachial artery was more impaired in patients with ED than in controls (2.36 vs. 3.92, p < 0.001). Coronary artery calcification was more frequent in individuals with ED than in control subjects (p = 0.01). Multiple logistic regression analysis showed that patients with ED had an overall odds ratio of 3.68 for having calcium score above the 75th percentile, compared to the controls.

CONCLUSIONS: Coronary atherosclerosis is more severe in patients with vascular ED; ED predicts the presence and extent of subclinical atherosclerosis independent of traditional risk factors for cardiovascular disease. Thus, ED may be considered an additional, early warning sign of coronary atherosclerosis.

Abbreviations and Acronyms   CAC = coronary artery calcification   CAD = coronary artery disease   ED = erectile dysfunction   FMD = flow-mediated dilation   IIEF = International Index of Erectile Function   MSCT = multi-slice computed tomography   NMD = nitroglycerin-mediated dilation

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