Introduction Erectile dysfunction (ED) is the persistent inability to attain or maintain an erection and affects up to 52% of men between the ages of 40 and 70. ED is an independent predictor of clinically overt cardiovascular (CV) events, coronary artery disease (CAD), stroke and all-cause mortality, preceding these by 2–5 years. ED has not been evaluated in patients referred to a rapid access chest pain clinic (RACPC) for suspected CAD.
Purpose To prospectively investigate ED in patients referred to the RACPC and to assess ED as an independent predictor of CAD in these patients.
Methods All male patients attending RACPC between October 2012 and February 2014 were eligible. ED was measured using a well validated 5-item International Index of Erectile function (IIEF-5) questionnaire, with ED being defined as IIEF-5 of ≤21 out of 25. ED was further categorised into mild-moderate (IIEF-5: 11–21) and severe (IIEF-5: ≤10). All patients underwent an exercise tolerance test (ETT) according to Bruce protocol where appropriate as a first line investigation. When this was not possible, patients underwent a functional imaging (stress echocardiography [SE] or myocardial perfusion scintigraphy [MPS]). Patients with positive or inconclusive studies went on to have coronary angiography (CA). Patients were considered to have CAD if they had a positive ETT, SE, MPS or CA. Results were analysed using Chi-squared test for categorical data and one-way ANOVA for continuous data. Stepwise Binary logistic regression model was used to determine the contribution of traditional risk factors and the presence of ED to the prediction of CAD. P-value less than 0.05 was considered significant.
Results Our study cohort constituted 181 patients. Of these, 26 (14%) could not complete IIEF-5. Of the remaining 155 participants, 53 (34%) had normal erectile function (IIEF-5: ≥22). Of 102 (66%) ED patients, 55 (36%) had mild-moderate ED and 47 (30%) had severe ED. Patients with ED reported more risk factors than patients without ED, including smoking (68% vs. 55%, p = 0.004), diabetes (9% vs. 23%, p = 0.029), and hypertension (30% vs. 56%, p = 0.002). More patients with ED had CAD (47% vs. 25%, p = 0.014).
Using stepwise Binary logistic regression including hypertension, hypercholesterolemia, smoking, diabetes, family history and ED as covariates, hypercholesterolemia (p = 0.045) and ED (p = 0.007) were significant independent predictors of CAD (r2=0.135, p = 0.001).
Conclusions ED may be a more powerful predictor of CAD in male patients with chest pain when compared to traditional vascular risk factors.
- Erectile Dysfunction
- Coronary Heart Disease
- Risk Prediction
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