Int J Clin Exp Med 2015;8(11):21295-21302 www.ijcem.com /ISSN:1940-5901/IJCEM0012380
Original Article The relation between erectile dysfunction and extent of coronary artery disease in the patients with stable coronary artery disease Hikmet Hamur1, Hakan Duman2, Ercument Keskin3, Sinan Inci4, Zafer Kucuksu1, Husnu Degirmenci1, Ergun Topal1 Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey; 2Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey; 3Department of Urology, Faculty of Medicine, Erzincan University, Erzincan, Turkey; 4Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey 1
Received July 4, 2015; Accepted October 19, 2015; Epub November 15, 2015; Published November 30, 2015 Abstract: Introduction: Erectile dysfunction (ED) and coronary artery disease (CAD) are closely related as a result of endothelial dysfunction leading to the restriction of blood flow. ED is a potential independent risk factor of CAD. We investigated the prevalence and severity of ED, the extent of CAD and the time interval between the symptoms of ED and CAD in the stable coronary artery patients. Materials and methods: 161 patients applied coronary angiography were divided into two groups according to SYNTAX score as group 1 (n=81) SYNTAX score ≤22, and group 2 (n=80) SYNTAX score >22. The prevalence and severity of ED was determined by using The International Index of Erectile Function (IIEF). Results: The prevalence of ED was 43.2% in group 1 and 61.3% in group 2 (P=0.022). The score of IIEF was 23.1 (15-29) in group 1, 19.3 (6-29) in group 2; there was a significant difference (P=0.000). In the multivariate logistic regression analysis carried out in order to determine the independent predictors on Syntax score, it was found that LDL (odds ratio: 1.032, 95% confidence interval: 1.009-1.055, P=0.007) and IIEF score (odds ratio: 0.825, 95% confidence interval: 0.733-0.928, P=0.001) were the independent predictors. The time between the symptoms of ED and CAD 30.1 ± 4.8 months in group 1, and 40.5 ± 4.3 months in group 2 (P=0.000). Conclusion: The severity of ED is an independent factor predicting the extent of CAD. The early detection of ED enables to make a cardiovascular evaluation. Therefore, taking the cardiovascular risk factors under an aggressive treatment may contribute to prevent the cardiovascular cases which may develop in the future. Keywords: Erectile dysfunction, coronary artery disease, international index of erectile function, syntax score
Introduction Erectile dysfunction (ED) is an inability to get and maintain an erection for a satisfying sexual relationship [1]. It has been showed in a recent study that the incidence of ED adjusted by age is 48.1% [2]. The International Index of Erectile Function (IIEF) is, today, one of the most commonly used forms for men admitting because of the sexual complaints. According to IIEF, the severity of ED is classified from mild to severe [3]. Organic ED and coronary artery disease (CAD) are closely related as a result of endothelial dysfunction leading to the restriction of blood flow [4, 5]. The similar risk factors including
obesity, diabetes mellitus (DM), smoking, hypertension (HT) and dyslipidemia are defined for both [6-9]. Diffuse atherosclerotic process affects the arterial blood flow and leads to the major pathophysiologic changes in both cardiovascular and peripheral vascular diseases including ED [10]. It was reported that the prevalence of ED has a high ratio like 75% in the patients diagnosed with CAD [11-16]. There are evidences supporting that ED is the predictor of CAD. An important part of the men with ED show the early signs of CAD. The men who previously had ED may get more severe CAD in proportion to the ones without CAD. The time between the beginning of the symptoms of ED and CAD is 2-3 years; also, the
Erectile dysfunction and extent of coronary artery disease occurrence time of cardiovascular event is approximately 3-5 years. ED has substantially increased mortality due to the relation with the mortality of CAD. As a result, the severity of ED is associated with the severity of CAD [17]. When the previous studies about the severity of ED and the severity of CAD were researched, it was seen that the patients with acute coronary syndrome were generally included in CAD group in the studies. The underlying root cause of acute coronary syndrome is atherosclerotic plaque rupture. However, the underlying pathology in the patients with stable coronary artery disease is endothelial dysfunction and atherosclerotic plaque burden. Also, in the previous studies, the numbers of epicardial vessels with stenosis above 50% and Gensini score were used in order to evaluate the extent of CAD. In our study, we used Syntax score, which is more current and provides better information about the complexity and extent of CAD, instead of Gensini score which is a classical scoring system. In the literature, among the studies evaluating the severity of ED and the extent of CAD, no study using Syntax score was encountered. Therefore, we think that this is the first study.
receiving long-term pharmacological treatment, the history of spinal cord injury, and the patients with previous pelvic, penile, urethral and prostate trauma or surgery. The patients with primary ED. The patients with normal coronary. The patients with acute coronary syndrome. All patients had the routine laboratory tests including lipid profile, fasting glucose, total and free testosterone levels. Diagnostic coronary angiography was applied to all patients by using the standard technique. The diagnostic coronary angiography was performed by using the standard techniques in all patients. If necessary, percutaneous transluminal coronary angioplasty or coronary artery bypass surgery was carried out within the time spent in hospital. In order to identify the cardiovascular risk factors, it was determined according to ESC/ ACC/AHA guidelines for HT to be >140/90 in three consecutive measurements in resting, DM fasting glucose level to be >126 mg/dl, and family history to have CAD for father at 22. The patient groups below were not included in the study: The patients with the history of percutaneous coronary intervention and coronary artery bypass surgery. The patients with liver disease, renal failure, thyroid disease, major depression 21296
Quantitative coronary angiography and syntax score
Erectile function evaluation All patients who stabilized after coronary angiography were carried out by the erectile function domain of the IIEF, a validated 15-item selfadministered questionnaire, that was translatInt J Clin Exp Med 2015;8(11):21295-21302
Erectile dysfunction and extent of coronary artery disease Table 1. Baseline clinical, laboratory and angiographic characteristics of the study population
Age (years) BMI (kg/m2) Total Cholesterol (mg/dl) LDL cholesterol (mg/dl) HDL cholesterol (mg/dl) TG (mg/dl) DM (%) HT (%) Cigarette smoking (%) Family history (%) Semptom interval (months) ED prevelance (%) IIEF score
Group 1 Syntax score ≤22, n=81 65.2 (45-76) 25.7 (20.3-27.9) 202.2 (169.6-244.4) 133.7 (101.2-176.8) 37.2 (29.4-52.7) 156.2 (88.0-339.3) 43.2% 48.1% 55.6% 38.3% 30.1 ± 4.8 43.2% 23.1 (15-29)
Group 2 Syntax score >22, n=80 66.8 (42-81) 25.7 (20.6-28.7) 213.9 (151.6-299.2) 146.4 (99.1-229.4) 36.69 (27.3-47.8) 154.1 (112.7-348.9) 61.3% 66.3% 58.8% 26.3% 40.5 ± 4.3 61.3% 19.3 (6-29)
P value 0.005 0.961 0.056 0.010 0.095 0.079 0.022 0.020 0.682 0.103 0.000 0.022 0.000
BMI: Body mass index, LDL: Low density lipoprotein, HDL: High density lipoprotein, TG: Triglyceride, DM: Diabetes mellitus, HT: Hypertension, ED: Erectile dysfunction, IIEF: International Index of Erectile Function.
Table 2. Effects of various variables on SYNTAX score□ Variables Multivariate OR (95% CI) Age (years) 1.022 (0.970-1.077) DM (%) 0.305 (0.084-1.101) HT (%) 0.576 (0.169-1.970) LDL cholesterol (mg/dl) 1.032 (1.009-1.055) IIEF score 0.825 (0.733-0.928)
p value 0.416 0.070 0.379 0.007 0.001
CI: confidence interval, OR: odds ratio, DM: Diabetes mellitus, HT: hypertension, LDL: low-density lipoprotein, IIEF: International Index of Erectile Function, □Multivariate logistic regression analysis. To identify the independent predictors of Syntax score, the parameters found to have statistical significance (P
Original Article The relation between erectile dysfunction and extent of coronary artery disease in the patients with stable coronary artery disease Hikmet Hamur1, Hakan Duman2, Ercument Keskin3, Sinan Inci4, Zafer Kucuksu1, Husnu Degirmenci1, Ergun Topal1 Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey; 2Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey; 3Department of Urology, Faculty of Medicine, Erzincan University, Erzincan, Turkey; 4Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey 1
Received July 4, 2015; Accepted October 19, 2015; Epub November 15, 2015; Published November 30, 2015 Abstract: Introduction: Erectile dysfunction (ED) and coronary artery disease (CAD) are closely related as a result of endothelial dysfunction leading to the restriction of blood flow. ED is a potential independent risk factor of CAD. We investigated the prevalence and severity of ED, the extent of CAD and the time interval between the symptoms of ED and CAD in the stable coronary artery patients. Materials and methods: 161 patients applied coronary angiography were divided into two groups according to SYNTAX score as group 1 (n=81) SYNTAX score ≤22, and group 2 (n=80) SYNTAX score >22. The prevalence and severity of ED was determined by using The International Index of Erectile Function (IIEF). Results: The prevalence of ED was 43.2% in group 1 and 61.3% in group 2 (P=0.022). The score of IIEF was 23.1 (15-29) in group 1, 19.3 (6-29) in group 2; there was a significant difference (P=0.000). In the multivariate logistic regression analysis carried out in order to determine the independent predictors on Syntax score, it was found that LDL (odds ratio: 1.032, 95% confidence interval: 1.009-1.055, P=0.007) and IIEF score (odds ratio: 0.825, 95% confidence interval: 0.733-0.928, P=0.001) were the independent predictors. The time between the symptoms of ED and CAD 30.1 ± 4.8 months in group 1, and 40.5 ± 4.3 months in group 2 (P=0.000). Conclusion: The severity of ED is an independent factor predicting the extent of CAD. The early detection of ED enables to make a cardiovascular evaluation. Therefore, taking the cardiovascular risk factors under an aggressive treatment may contribute to prevent the cardiovascular cases which may develop in the future. Keywords: Erectile dysfunction, coronary artery disease, international index of erectile function, syntax score
Introduction Erectile dysfunction (ED) is an inability to get and maintain an erection for a satisfying sexual relationship [1]. It has been showed in a recent study that the incidence of ED adjusted by age is 48.1% [2]. The International Index of Erectile Function (IIEF) is, today, one of the most commonly used forms for men admitting because of the sexual complaints. According to IIEF, the severity of ED is classified from mild to severe [3]. Organic ED and coronary artery disease (CAD) are closely related as a result of endothelial dysfunction leading to the restriction of blood flow [4, 5]. The similar risk factors including
obesity, diabetes mellitus (DM), smoking, hypertension (HT) and dyslipidemia are defined for both [6-9]. Diffuse atherosclerotic process affects the arterial blood flow and leads to the major pathophysiologic changes in both cardiovascular and peripheral vascular diseases including ED [10]. It was reported that the prevalence of ED has a high ratio like 75% in the patients diagnosed with CAD [11-16]. There are evidences supporting that ED is the predictor of CAD. An important part of the men with ED show the early signs of CAD. The men who previously had ED may get more severe CAD in proportion to the ones without CAD. The time between the beginning of the symptoms of ED and CAD is 2-3 years; also, the
Erectile dysfunction and extent of coronary artery disease occurrence time of cardiovascular event is approximately 3-5 years. ED has substantially increased mortality due to the relation with the mortality of CAD. As a result, the severity of ED is associated with the severity of CAD [17]. When the previous studies about the severity of ED and the severity of CAD were researched, it was seen that the patients with acute coronary syndrome were generally included in CAD group in the studies. The underlying root cause of acute coronary syndrome is atherosclerotic plaque rupture. However, the underlying pathology in the patients with stable coronary artery disease is endothelial dysfunction and atherosclerotic plaque burden. Also, in the previous studies, the numbers of epicardial vessels with stenosis above 50% and Gensini score were used in order to evaluate the extent of CAD. In our study, we used Syntax score, which is more current and provides better information about the complexity and extent of CAD, instead of Gensini score which is a classical scoring system. In the literature, among the studies evaluating the severity of ED and the extent of CAD, no study using Syntax score was encountered. Therefore, we think that this is the first study.
receiving long-term pharmacological treatment, the history of spinal cord injury, and the patients with previous pelvic, penile, urethral and prostate trauma or surgery. The patients with primary ED. The patients with normal coronary. The patients with acute coronary syndrome. All patients had the routine laboratory tests including lipid profile, fasting glucose, total and free testosterone levels. Diagnostic coronary angiography was applied to all patients by using the standard technique. The diagnostic coronary angiography was performed by using the standard techniques in all patients. If necessary, percutaneous transluminal coronary angioplasty or coronary artery bypass surgery was carried out within the time spent in hospital. In order to identify the cardiovascular risk factors, it was determined according to ESC/ ACC/AHA guidelines for HT to be >140/90 in three consecutive measurements in resting, DM fasting glucose level to be >126 mg/dl, and family history to have CAD for father at 22. The patient groups below were not included in the study: The patients with the history of percutaneous coronary intervention and coronary artery bypass surgery. The patients with liver disease, renal failure, thyroid disease, major depression 21296
Quantitative coronary angiography and syntax score
Erectile function evaluation All patients who stabilized after coronary angiography were carried out by the erectile function domain of the IIEF, a validated 15-item selfadministered questionnaire, that was translatInt J Clin Exp Med 2015;8(11):21295-21302
Erectile dysfunction and extent of coronary artery disease Table 1. Baseline clinical, laboratory and angiographic characteristics of the study population
Age (years) BMI (kg/m2) Total Cholesterol (mg/dl) LDL cholesterol (mg/dl) HDL cholesterol (mg/dl) TG (mg/dl) DM (%) HT (%) Cigarette smoking (%) Family history (%) Semptom interval (months) ED prevelance (%) IIEF score
Group 1 Syntax score ≤22, n=81 65.2 (45-76) 25.7 (20.3-27.9) 202.2 (169.6-244.4) 133.7 (101.2-176.8) 37.2 (29.4-52.7) 156.2 (88.0-339.3) 43.2% 48.1% 55.6% 38.3% 30.1 ± 4.8 43.2% 23.1 (15-29)
Group 2 Syntax score >22, n=80 66.8 (42-81) 25.7 (20.6-28.7) 213.9 (151.6-299.2) 146.4 (99.1-229.4) 36.69 (27.3-47.8) 154.1 (112.7-348.9) 61.3% 66.3% 58.8% 26.3% 40.5 ± 4.3 61.3% 19.3 (6-29)
P value 0.005 0.961 0.056 0.010 0.095 0.079 0.022 0.020 0.682 0.103 0.000 0.022 0.000
BMI: Body mass index, LDL: Low density lipoprotein, HDL: High density lipoprotein, TG: Triglyceride, DM: Diabetes mellitus, HT: Hypertension, ED: Erectile dysfunction, IIEF: International Index of Erectile Function.
Table 2. Effects of various variables on SYNTAX score□ Variables Multivariate OR (95% CI) Age (years) 1.022 (0.970-1.077) DM (%) 0.305 (0.084-1.101) HT (%) 0.576 (0.169-1.970) LDL cholesterol (mg/dl) 1.032 (1.009-1.055) IIEF score 0.825 (0.733-0.928)
p value 0.416 0.070 0.379 0.007 0.001
CI: confidence interval, OR: odds ratio, DM: Diabetes mellitus, HT: hypertension, LDL: low-density lipoprotein, IIEF: International Index of Erectile Function, □Multivariate logistic regression analysis. To identify the independent predictors of Syntax score, the parameters found to have statistical significance (P
