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CLINICAL RESEARCH: ERECTILE DYSFUNCTION AND CARDIAC DISEASE

Erectile Dysfunction as a Predictor of Cardiovascular Events and Death in Diabetic Patients With Angiographically Proven Asymptomatic Coronary Artery Disease

A Potential Protective Role for Statins and 5-Phosphodiesterase Inhibitors

Carmine Gazzaruso, MD, PhD^_*,_*, Sebastiano B. Solerte, MD, Arturo Pujia, MD, Adriana Coppola, RN, MS^_*, Monia Vezzoli, MD^_*, Fabrizio Salvucci, MD^_*, Cinzia Valenti, MD^_*, Andrea Giustina, MD^|| and Adriana Garzaniti, MD

^_* Cardio-Metabolic Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo," Hospital Group San Donato, Vigevano, Italy
Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
Diabetes Centre, A.O. Province of Pavia, Pavia, Italy
Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, Italy
^|| Endocrinology Unit, University of Brescia, Brescia, Italy.

Manuscript received June 18, 2007; revised manuscript received October 9, 2007, accepted October 15, 2007.

^_* Reprint requests and correspondence: Dr. Carmine Gazzaruso, Clinical Institute "Beato Matteo," Via Aselli, 5, 27100 Pavia, Italy. (Email: c.gazzaruso{at}tele2.it).

Objectives: We sought to investigate whether erectile dysfunction (ED) is a predictor of future cardiovascular events and death in diabetic patients with silent coronary artery disease (CAD) and whether there are predictors of cardiovascular events and death among CAD diabetic patients with ED.

Background: Case-control studies showed that ED is associated with CAD in diabetic patients, but no prospective study is available.

Methods: Type 2 diabetic men (n = 291) with silent CAD angiographically documented were recruited. Erectile dysfunction was assessed by the International Index Erectile Function-5 questionnaire.

Results: During a follow-up period of 47.2 ± 21.8 months (range 4 to 82 months), 49 patients experienced major adverse cardiac events (MACE). The difference in ED prevalence between patients with and those without MACE was significant (61.2% vs. 36.4%; p = 0.001). Cox regression analysis showed that ED predicted MACE (hazard ratio [HR] 2.1; 95% confidence interval [CI] 1.6 to 2.6; p < 0.001). Among patients with CAD and ED, the Kaplan-Meier method showed that the statin (Mantel log-rank test: 3.921; p = 0.048) and 5-phosphodiesterase (5-PDE) inhibitor use (Mantel log-rank test: 4.608; p = 0.032) were associated with a lower rate of MACE. Cox regression analysis showed that statin use (HR 0.66; 95% CI 0.46 to 0.97; p = 0.036) reduced MACE. Treatment with 5-PDE inhibitors did not enter the model, but its p value was very near to the significant level (HR 0.68; 95% CI 0.46 to 1.01; p = 0.056).

Conclusions: Our data first show that ED is a powerful predictor of cardiovascular morbidity and mortality in diabetic patients with silent CAD and that the treatment with statins and 5-PDE inhibitors might reduce the occurrence of MACE among CAD diabetic patients with ED.

Abbreviations and Acronyms   5-PDE = 5-phosphodiesterase   CAD = coronary artery disease   CI = confidence interval   ECG = electrocardiogram   ED = erectile dysfunction   HR = hazard ratio   IIEF-5 = International Index Erectile Function-5   MACE = major adverse cardiac events

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