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CLINICAL RESEARCH: ERECTILE DYSFUNCTION AND CARDIAC DISEASE

Erectile Dysfunction Predicts Coronary Heart Disease in Type 2 Diabetes

Ronald Ching-Wan Ma, MA^_*, Wing-Yee So, MBChB^_*, Xilin Yang, PhD^_*, Linda Wai-Ling Yu, MBChB^_*, Alice Pik-Shan Kong, MBChB^_*,, Gary Tin-Choi Ko, MD, Chun-Chung Chow, MBBS^_*, Clive Stewart Cockram, MD^_*, Juliana Chung-Ngor Chan, MD^_*, and Peter Chun-Yip Tong, PhD^_*,,_*

^_* Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.

Manuscript received October 2, 2007; revised manuscript received January 30, 2008, accepted February 5, 2008.

^_* Reprint requests and correspondence: Dr. Peter C. Y. Tong, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China. (Email: ptong{at}cuhk.edu.hk).

Objectives: We examined the predictive power of erectile dysfunction (ED) on coronary heart disease (CHD) events in Chinese men with type 2 diabetes.

Background: Subjects with diabetes are prone to develop cardiovascular complications. Erectile dysfunction is strongly associated with CHD in cross-sectional studies, but prospective data are lacking.

Methods: A consecutive cohort of men with no clinical evidence of cardiovascular disease underwent comprehensive assessments for diabetic complications. Erectile dysfunction was defined according to the definition of the National Institutes of Health Consensus Conference 1992. Coronary heart disease events were censored with centralized territory-wide hospital databases in 2005.

Results: Of 2,306 subjects (age: 54.2 ± 12.7 years; follow-up: 4.0 [range 1.7 to 7.1] years), 26.7% had ED at baseline. The incidence of CHD events was higher in men with ED than those without (19.7/1,000 person-years, 95% confidence interval [CI] 14.3 to 25.2 person-years vs. 9.5/1,000 person-years, 95% CI 7.4 to 11.7 person-years). Men who developed CHD events were older; had a higher frequency of ED and microvascular complications; had longer duration of diabetes; and had higher blood pressure, total cholesterol, low-density lipoprotein cholesterol, and urinary albumin/creatinine ratio but lower high-density lipoprotein cholesterol and estimated glomerular filtration rate than those without CHD events. Erectile dysfunction remained an independent predictor for CHD events (hazard ratio 1.58, 95% CI 1.08 to 2.30, p = 0.018) after adjustment for other covariates along with age, duration of disease, and use of antihypertensive agents and albuminuria.

Conclusions: In type 2 diabetic men without clinically overt cardiovascular disease, the presence of ED predicts a new onset of CHD events. Symptoms of ED should be independently sought to identify high-risk subjects for comprehensive cardiovascular assessments.

Abbreviations and Acronyms   ACEI = angiotensin-converting enzyme inhibitor   ACR = albumin/creatinine ratio   ARB = angiotensin receptor blocker   CHD = coronary heart disease   CI = confidence interval   DBP = diastolic blood pressure   ED = erectile dysfunction   eGFR = estimated glomerular filtration rate   IIEF = International Index of Erectile Function   PAD = peripheral arterial disease   SBP = systolic blood pressure

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