ED as a Predictor of Occult CAD

June 24, 2014 admin Erectile Dysfunction Articles

In a recently reported population-based study (the Krimpen study), a single question on erectile rigidity (from the International Continence Society male sex questionnaire) was shown to be a predictor for the combined outcome of acute MI, stroke, and sudden death, independently of risk factors in the Framingham risk profile. Men (aged 50a��75, free of prostate and bladder disease) canadian health care mall pharmacy were followed up for an average of 6.3 years. Of those men who did not have CVD at baseline (n = 1,248), 258 (22.8%) had severely reduced erectile rigidity.

Fifty eight cardiovascular events occurred in the 7,945 person-year follow-up. After adjusting for age and CVD risk score, the hazard ratios (95% CI) were 1.6 (1.2a��2.3) and 2.6 (1.3a��5.2) for reduced and severely reduced erectile rigidity, respectively.

Recent findings suggest there is a strong temporal relationship between ED and CAD, with ED preceding a cardiovascular event by at least 2a��5 years. This temporal relationship was investigated in a questionnaire-based study that included 207 patients with CVD attending cardiovascular rehabilitation programs and 165 age-matched controls from general practice in the United Kingdom. Patients completed up to four questionnaires including the IIEF. Of the individuals with CVD, 56% were experiencing symptoms of ED at the time of the study and had done so for a mean of 5 A� 5.3 years. In contrast, 37% of individuals in the control group had ED symptoms for a mean of 6.6 A� 6.8 years. Of particular concern, the study highlighted that only 53% of the CVD group and 43% of the control group had actually discussed their ED symptoms with a health professional.

In a study of 147 men presenting with acute coronary syndrome (plaque rupture), documented ED and CAD, Montorsi et al. reported the presence of clinically evident ED symptoms in 99 patients (67%) developed ~3 years (mean 38.8 months, range 1a��168 months) prior to the acute event.

In the subsequent AssoCiation Between eRectile dysfunction and coronary Artery disease (COBRA) trial, 93% of patients with a chronic coronary syndrome reported ED symptoms before the onset of angina pectoris, with a mean interval of 24 (range 12a��36) months. This finding further reinforces the concept of a lead time of at least 2a��5 years between the development of ED and symptomatic CAD. The time intervals (range) for patients with one, two and, three vessel disease were 12 (9.5a��24), 24 (16.5a��36), and 33 (21a��47) months, respectively. There was a significant relationship between the length of time from ED to CAD onset and the number of vessels involved (p = 0.016). Importantly, given that men with ED may be at cardio-vascular risk, this a�?longa�? lead time provides an early opportunity for cardiovascular risk reduction.

Key Points

  • ED may be a marker for asymptomatic CAD.
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  • ED can occur 3a��5 years before a cardiac event.
  • ED should trigger a cardiac risk assessment and aggressive cardiac risk factor reduction.

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