Korean J Urol.  2006 Mar;47(3):279-286. 10.4111/kju.2006.47.3.279.

Erectile Dysfunction in the Patients with Cardiovascular Disease

• Kim HW
• Park WJ
• Cho SY

• KMID: 2294175
• DOI: http://doi.org/10.4111/kju.2006.47.3.279

Abstract

PURPOSE: This study was designed to evaluate the prevalence of erectile dysfunction (ED), and the correlations of ED with cardiovascular disease (CVD) and the antihypertensive drugs that are used for CVD patients as risk factors.
MATERIALS AND METHODS
A total of 200 cardiology outpatients suffering with CVD were enrolled in this study. The patients were screened for ED by using questionnaire that included the 5-item Version of the International Index of Erectile Function (IIEF-5); the patients were reviewed for a medical history, including the risk factors for CVD and their current antihypertensive medications.
RESULTS
Overall, 58% of the patients had various degrees of ED, including mild in 9.5%, moderate in 2.5% and complete dysfunction in 46%. The prevalence of complete ED was significantly higher than the other ED types. The risk factors for patients with CVD were hypertension (70.0%), smoking (61.5%), coronary artery disease (CAD) (55.0%), overweight (47.0%), age (40.5%), lipid abnormalities (24.5%) and diabetes (16.5%). Especially, the patients having an older age, CAD and smoking had a significantly higher prevalence of ED than those patients with the other risk factors. Although the patients treated with angiotensin converting enzyme (ACE) inhibitors showed significant correlations for the antihypertensive drugs with the prevalence of ED, all the antihypertensive drugs were not independently associated with the presence of ED on the multivariable logistic regression test.
CONCLUSIONS
This study provides data on the prevalence of ED and the significant correlation of ED with old age, CAD and smoking for the patients with CVD. Although it is a well known fact that CVD is associated with ED, most physicians do not ask the patients questions about it, and most of the patients are too embarrassed to discuss their ED with them. Therefore, understanding the relationship between ED and CVD is essential.

Keyword

Erectile dysfunction; Cardiovascular disease

MeSH Terms

Antihypertensive Agents
Cardiology
Cardiovascular Diseases*
Coronary Artery Disease
Erectile Dysfunction*
Humans
Hypertension
Logistic Models
Male
Outpatients
Overweight
Peptidyl-Dipeptidase A
Prevalence
Surveys and Questionnaires
Risk Factors
Smoke
Smoking
Antihypertensive Agents
Peptidyl-Dipeptidase A
Smoke

Figure

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  Fig. 1 Severity of erectile dysfunction in the patients with cardiovascular disease according to International Index of Erectile Function (IIEF)-5 score.

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  Fig. 2 Distribution of the patients according to cardiovascular risk factors and erectile dysfunction. *significant at p<0.05, ED: erectile dysfunction, HBP: hypertension, CAD: coronary artery disease, DM: diabetes mellitus.

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  Fig. 3 Distribution of the patients according to antihypertensive drugs and erectile dysfunction. All the antihypertensive drugs were not independently associated with presence of ED on the multivariable logistic regression test. ED: erectile dysfunction, *Ca.-Ch. blockers: calcium-channel blockers, †ACE inhibitors: angiotensin converting enzyme inhibitors, ‡Ang.-II R. antagonists: angiotensin-II receptor antagonists.

Reference

1. NIH Consensus Development Panel on Impotence. National Institutes of Health (NIH) Consensus Conference. Impotence. JAMA. 1993. 270:83–90.

2. Ayta IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int. 1999. 84:50–56.

3. Kinsey AC, Pomeroy WR, Martin CE. Sexual behavior in the human male. 1948. Am J Public Health. 2003. 93:894–898.

4. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994. 151:54–61.

5. Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB, et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med. 2000. 30:328–338.

6. Ledda A. Cigarette smoking, hypertension and erectile dysfunction. Curr Med Res Opin. 2000. 16:Suppl 1. S13–S16.

7. Park JY, Kim SW, Paick JS. How can we predict asymptomatic myocardial ischemia in patients with vasculogenic impotence? Korean J Urol. 2002. 43:67–71.

8. McKinlay JB. The worldwide prevalence and epidemiology of erectile dysfunction. Int J Impot Res. 2000. 12:Suppl 4. S6–S11.

9. Panser LA, Rhodes T, Girman CJ, Guess HA, Chute CG, Oesterling JE, et al. Sexual function of men ages 40 to 79 years: the Olmsted County Study of Urinary Symptoms and Health Status among Men. J Am Geriatr Soc. 1995. 43:1107–1111.

10. Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol. 2000. 163:460–463.

11. Son HC, Byun SS, Park EC, Cho KS, Jo MK, Kim SW, et al. Prevalence of sexual dysfunction in men older than 40 living in Seoul: epidemiologic survey using questionnaire. Korean J Urol. 2002. 43:52–61.

12. Greenstein A, Chen J, Miller H, Matzkin H, Villa Y, Braf Z. Does severity of ischemic coronary disease correlate with erectile dysfunction? Int J Impot Res. 1997. 9:123–126.

13. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999. 281:537–544.

14. Kloner RA, Mullin SH, Shook T, Matthews R, Mayeda G, Burstein S, et al. Erectile dysfunction in the cardiac patient: How common and should we treat? J Urol. 2003. 170:S46–S50.

15. Naya Y, Mizutani Y, Ochiai A, Soh J, Kawauchi A, Fujito A, et al. Preliminary report of association of chronic diseases and erectile dysfunction in middle-aged men in Japan. Urology. 2003. 62:532–536.

16. Morley JE, Kaiser FE. Sexual function with advancing age. Med Clin North Am. 1989. 73:1483–1495.

17. Azarbal B, Mirocha J, Shah PK. Adverse cardiovascular events associated with the use of Viagra. J Am Coll Cardiol. 2000. 35:Suppl. 553A.

18. Conti CR, Pepine CJ, Sweeney M. Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease. Am J Cardiol. 1999. 83:29C–34C.

19. Brindis RG, Kloner RA. Sildenafil in patients with cardiovascular disease. Am J Cardiol. 2003. 92:26M–36M.

20. Padma-nathan H, Eardley I, Kloner RA, Laties AM, Montorsi F. A 4-year update on the safety of sildenafil citrate (Viagra). Urology. 2002. 60:2 Suppl 2. 67–90.

21. Kloner RA, Hutter AM, Emmick JT, Mitchell MI, Denne J, Jackson G. Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol. 2003. 42:1855–1860.

22. Kloner RA, Mitchell M, Emmick JT. Cardiovascular effects of tadalafil. Am J Cardiol. 2003. 92:37M–46M.

23. Derby CA, Mohr BA, Goldstein I, Feldman HA, Johannes CB, Mckinlay JB. Modifiable risk factors and erectile dysfunction: Can lifestyle change modify risk? Urology. 2000. 56:302–306.

24. Fung MM, Bettencourt R, Barrett-Connor E. Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo study. J Am Coll Cardiol. 2004. 43:1405–1411.

25. Seftel AD, Sun P, Swindle R. The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol. 2004. 171:2341–2345.

26. Shabsigh R, Fishman IJ, Schum C, Dunn JK. Cigarette smoking and other vascular risk factors in vasculogenic impotence. Urology. 1991. 38:227–231.

27. Burchardt M, Burchardt T, Baer L, Kiss AJ, Pawar RV, Shabsigh A, et al. Hypertension is associated with severe erectile dysfunction. J Urol. 2000. 164:1188–1191.

28. Rosas SE, Joffe M, Franklin E, Strom BL, Kotzker W, Brensinger C, et al. Prevalence and determinants of erectile dysfunction in hemodialysis patients. Kidney Int. 2001. 59:259–266.

29. Fogari R, Zoppi A. Effects of antihypertensive therapy on sexual activity in hypertensive men. Curr Hypertens Rep. 2002. 4:202–210.

30. Khan MA, Morgan RJ, Mikhailidis DP. The choice of antihypertensive drugs in patients with erectile dysfunction. Curr Med Res Opin. 2002. 18:103–107.