This Article Figures Only Full Text Full Text (PDF) View CVN Genuine Article View Related Story on Cardiosmart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gazzaruso, C. Articles by Garzaniti, A. Search for Related Content PubMed PubMed Citation Articles by Gazzaruso, C. Articles by Garzaniti, A. Related Collections Related Articles

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

Related Articles

Erectile Dysfunction: The New Harbinger for Major Adverse Cardiac Events in the Diabetic Patient

Robert A. Kloner
J. Am. Coll. Cardiol. 2008 51: 2051-2052. [Full Text] [PDF]

This article has been cited by other articles:

				S. La Vignera, R. Condorelli, E. Vicari, R. D'Agata, and A. E. Calogero Circulating Endothelial Progenitor Cells and Endothelial Microparticles in Patients With Arterial Erectile Dysfunction and Metabolic Syndrome J Androl, March 1, 2012; 33(2): 202 - 209. [Abstract] [Full Text] [PDF]

				R. Lorusso, S. Gelsomino, F. Luca, G. De Cicco, G. Bille, R. Carella, E. Villa, G. Troise, M. Vigano, C. Banfi, et al. Type 2 Diabetes Mellitus Is Associated With Faster Degeneration of Bioprosthetic Valve: Results From a Propensity Score-Matched Italian Multicenter Study Circulation, January 31, 2012; 125(4): 604 - 614. [Abstract] [Full Text] [PDF]

				Collaborative Depression and Sexual dysfunction (C Prevalence and correlates of erectile dysfunction in men on chronic haemodialysis: a multinational cross-sectional study Nephrol. Dial. Transplant., December 29, 2011; (2011) gfr635v1. [Abstract] [Full Text] [PDF]

				K.- E. Andersson Mechanisms of Penile Erection and Basis for Pharmacological Treatment of Erectile Dysfunction Pharmacol. Rev., December 1, 2011; 63(4): 811 - 859. [Abstract] [Full Text] [PDF]

				B. P. Gupta, M. H. Murad, M. M. Clifton, L. Prokop, A. Nehra, and S. L. Kopecky The Effect of Lifestyle Modification and Cardiovascular Risk Factor Reduction on Erectile Dysfunction: A Systematic Review and Meta-analysis Arch Intern Med, November 14, 2011; 171(20): 1797 - 1803. [Abstract] [Full Text] [PDF]

				J.-Y. Dong, Y.-H. Zhang, and L.-Q. Qin Erectile dysfunction and risk of cardiovascular disease meta-analysis of prospective cohort studies. J. Am. Coll. Cardiol., September 20, 2011; 58(13): 1378 - 1385. [Abstract] [Full Text] [PDF]

				S. La Vignera, R. A. Condorelli, E. Vicari, R. D'Agata, and A. E. Calogero New Immunophenotype of Blood Endothelial Progenitor Cells and Endothelial Microparticles in Patients With Arterial Erectile Dysfunction and Late-Onset Hypogonadism J Androl, September 1, 2011; 32(5): 509 - 517. [Abstract] [Full Text] [PDF]

				M. M. Miner Erectile Dysfunction: A Harbinger or Consequence: Does Its Detection Lead to a Window of Curability? J Androl, March 1, 2011; 32(2): 125 - 134. [Abstract] [Full Text] [PDF]

				B. G. Schwartz and R. A. Kloner Clinical Cardiology: Physician Update: Erectile Dysfunction and Cardiovascular Disease Circulation, January 4, 2011; 123(1): 98 - 101. [Full Text] [PDF]

				G. D. Batty, Q. Li, S. Czernichow, B. Neal, S. Zoungas, R. Huxley, A. Patel, B. E. de Galan, M. Woodward, P. Hamet, et al. Erectile Dysfunction and Later Cardiovascular Disease in Men With Type 2 Diabetes: Prospective Cohort Study Based on the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) Trial J. Am. Coll. Cardiol., November 30, 2010; 56(23): 1908 - 1913. [Abstract] [Full Text] [PDF]

				M. Bohm, M. Baumhakel, K. Teo, P. Sleight, J. Probstfield, P. Gao, J. F. Mann, R. Diaz, G. R. Dagenais, G. L. R. Jennings, et al. Erectile Dysfunction Predicts Cardiovascular Events in High-Risk Patients Receiving Telmisartan, Ramipril, or Both: The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials Circulation, March 30, 2010; 121(12): 1439 - 1446. [Abstract] [Full Text] [PDF]

				A. B. Araujo, S. A. Hall, P. Ganz, G. R. Chiu, R. C. Rosen, V. Kupelian, T. G. Travison, and J. B. McKinlay Does Erectile Dysfunction Contribute to Cardiovascular Disease Risk Prediction Beyond the Framingham Risk Score? J. Am. Coll. Cardiol., January 26, 2010; 55(4): 350 - 356. [Abstract] [Full Text] [PDF]

				A. Aversa, R. Bruzziches, D. Francomano, M. Natali, and A. Lenzi Testosterone and phosphodiesterase type-5 inhibitors: new strategy for preventing endothelial damage in internal and sexual medicine? Therapeutic Advances in Urology, October 1, 2009; 1(4): 179 - 197. [Abstract] [PDF]

				G. I Hackett Review: Androgens, erectile dysfunction and cardiovascular risk in type 2 diabetes The British Journal of Diabetes & Vascular Disease, September 1, 2009; 9(5): 214 - 217. [Abstract] [PDF]

				M. M. Miner Erectile Dysfunction and the "Window of Curability": A Harbinger of Cardiovascular Events Mayo Clin. Proc., February 1, 2009; 84(2): 102 - 104. [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, J. J. Bax, G. K. Feld, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, S. M. Narayan, D. J. Sahn, et al. Highlights of the Year in JACC 2008 J. Am. Coll. Cardiol., January 27, 2009; 53(4): 373 - 398. [Full Text] [PDF]

				I. W Campbell Erectile dysfunction in diabetes mellitus: a risk factor for cardiovascular disease The British Journal of Diabetes & Vascular Disease, September 1, 2008; 8(5): 212 - 213. [PDF]

				Erectile Dysfunction: A New Risk Factor for Heart Disease Journal Watch Cardiology, June 25, 2008; 2008(625): 4 - 4. [Full Text]

				R. A. Kloner Erectile Dysfunction: The New Harbinger for Major Adverse Cardiac Events in the Diabetic Patient J. Am. Coll. Cardiol., May 27, 2008; 51(21): 2051 - 2052. [Full Text] [PDF]