The Correlation between Erectile Dysfunction and the Severity of Coronary Artery Involvement in Patients with Coronary Artery Disease

Hyun Woo Kim; Wang Jin Park; Yong Sun Choi; Soo Yeun Cho

doi:10.4111/kju.2007.48.1.94

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Kim, Park, Choi, and Cho: The Correlation between Erectile Dysfunction and the Severity of Coronary Artery Involvement in Patients with Coronary Artery Disease

Original Article

Korean J Urol 2007;48(1):94-102.

Published online: 18 December 2007

DOI: https://doi.org/10.4111/kju.2007.48.1.94

The Correlation between Erectile Dysfunction and the Severity of Coronary Artery Involvement in Patients with Coronary Artery Disease

Hyun Woo Kim, Wang Jin Park, Yong Sun Choi, Soo Yeun Cho

¹From the Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea

Corresponding Author: Jo Su-yeon Catholic University College of Medicine Department of Urology, St. Paul's Hospital Jeonnong 2-dong, Dongdaemun-gu, Seoul 620-56 ? 130-709 TEL: 02-958-2155 FAX: 02-960-2746 E-mail: urocsy@yahoo.com.kr

Received 20 February 2006 Accepted 27 November 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Erectile dysfunction (ED) may be considered as a clinical manifestation of generalized vascular disease. This study aimed to assess the correlation between ED and the severity of the involved coronary artery in patients with coronary artery disease (CAD).

Materials and Methods:

255 men with CAD, who underwent coronary angiography (CAG), were evaluated for erectile function using a questionnaire that included a 5-item Version the International Index of Erectile Function (IIEF-5). Cardiovascular risk factors were also reviewed. The correlation between erectile function and the number of involved coronary vessels, age and number of accompanying cardiovascular risk factors were analyzed.

Results:

Of the patients, 59.6% had various degrees of ED, which were subdivided into mild (21.7%), moderate (14.5%) and complete (63.8%) according to the severity. The cardiovascular risk factors were hypertension, smoking, overweight, age, lipid abnormalities and diabetes in 67.8, 67.5, 47.1, 38.4, 28.6 and 19.6%, respectively. One, two and three coronary vessels were involved in 26.3, 27.4 and 21.2%, respectively, while 25.1% showed non specific finding on CAG, despite abnormal findings in the resting ECG and treadmill exercise test. Erectile function decreased significantly according to the increasing number of involved coronary vessels (p く 0.05), age (p く 0.0㢌) and accompanying cardiovascular risk factors (p く 0.05). Of the cardiovascular risk factors, age, smoking and diabetes had negative effects on erectile function (p く 0.05) in patients with CAD.

Conclusions:

Statistically significant correlations were demonstrated between ED and the number of involved coronary vessels, age and the number of accompanying cardiovascular risk factors in patients with CAD. Furthermore, in patients with symptoms of chest discomfort, although CAG showed non specific findings, the possibility of hidden ED will need to be investigated. (Korean J Urol 2007;48:94-102)

Keywords: Coronary artery disease, Erectile dysfunction, Risk factors, Coronary angiography

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Fig. 1.

Relationship between ED/IIEF-5 and age (p<0.001, pく 0.001). ED: erectile dysfunction, IIEF-5: 5-item Version the International Index of Erectile Function.

Fig. 2.

Relationship between ED/IIEF-5 and severity of CAD (p=0.003, p>0.05). ED: erectile dysfunction, IIEF-5: 5-item Version the International Index of Erectile Function, CAD: coronary artery disease, N-S Fx.: non-specific finding, CAG: coronary angiography, Ds.: disease.

Table 1.

Clinical characteristics of the patients

Parameters	No. of patients (%)
No. of patients	255
	63.4±8.6
Age (years, mean±SD, range)	(39-83)
ED	152 (59.6)
Mild	33 (21.7)
Moderate	22 (14.5)
Complete	97 (63.8)
IIEF-5 (mean± SD)	14.3±7.8
Risk factors
Smoking	172 (67.5)
Overweight(BMI>25)	120 (47.1)
BMI (mean± SD)	26.4±3.7
Hypertension (BP > 140/90mmHg)	173 (67.8)
Age (>65 years)	98 (38.4)
DM (FBS>140mg/dl)	50 (19.6)
Hyperlipidemia (total cholesterol > 200mg/dl)	73 (28.6)
No. of risk factors
No	3(1.2)
Single	31 (12.1)
Double	75 (29.4)
Triple	89 (34.9)
More than quadruple	57 (22.4)
Age (years)
Less than 50	31 (12.2)
51-60	73 (28.6)
61-70	111 (43.5)
More than 71	40 (15.7)
Fx. of CAG
Non specific Fx. on CAG	64 (25.1)
One VD	67 (26.3)
Two VD	70 (27.4)
Three YD	54 (21.2)

ED: erectile dysfunction, IIEF-5: 5-item Version the International Index of Erectile Function, BMI: body mass index, BP: blood pressure, DM: diabetes mellitus, FBS: fasting blood sugar, Fx.: finding, CAG: coronary angiography, VD: vessel disease

Table 2.

Prevalence of ED and risk factors in the patients with CAD

Parameters	No. ED (%)	ED (%)	Chi-square test
Parameters	No. ED (%)	ED (%)	p-value
No. of patients	103 (40.4)	152 (59.6)
IIEF-5 (mean±SD)	21.7±3.2	9.5±4.7
Risk factors
Smoking	80 (46.5)	92 (53.5)	0.004
Overweight(BMI>25)	49 (40.8)	71 (59.2)	0.892
BMI (mean±SD)	26.3±3.4	26.7±3.8
Hypertension (BP>140/90mmHg)	75 (43.4)	98 (56.6)	0.162
Age (≥ 65 years)	18 (18.4)	80 (81.6)	< 0.001
(years, mean±SD)	57.5±8.4	65.8±7.3
Less than 50	25 (80.6)	6 (19.4)
51-60	37 (50.7)	36 (49.3)
61-70	32 (28.8)	79 (71.2)
More than 71	9 (22.5)	31 (77.5)
DM (FBS>140mg/dl)	12 (24.0)	38 (76.0)	0.008
Hyperlipidemia (total cholesterol > 200mg/dl)	25 (34.2)	48 (65.8)	0.205
No. of risk factors
No	1 (33.3)	2 (66.7)
Single	14 (45.2)	17 (54.8)
Double	32 (42.7)	43 (57.3)
Triple	43 (48.3)	46 (51.7)
More than quadruple	13 (22.8)	44 (77.2)
Fx. of CAG			0.018
Non specific Fx.	36 (56.3)	28 (43.7)
One VD	27 (40.3)	40 (59.7)
Two VD	23 (32.9)	47 (67.1)
Three VD	17 (31.5)	37 (68.5)

ED: erectile dysfunction, CAD: coronary artery disease, IIEF-5: 5-item Version the International Index of Erectile Function, BMI: body mass index, DM: diabetes mellitus, Fx.: finding, CAG: coronary angiography, VD: vessel disease

Table 3.

Clinical characteristics of the patients with CAD according to the CAG results

Parameters	Non specific Fx. on CAG (%)	One VD (%)	Two VD (%)	Three VD (%)
No. of patients	64 (25.1)	67 (26.3)	70 (27.5)	54 (21.1)
Age (years, mean±SD)	61.4±8.2	63.7±6.9	62.6±7.4	63.5±9.1
ED	28 (43.7)	40 (59.7)	47 (67.1)	37 (68.5)
Mild	7 (25.0)	9 (22.5)	10(21.3)	7 (18.9)
Moderate	4 (14.3)	4 (10.0)	7 (14.9)	7 (18.9)
Complete	17 (60.7)	27 (67.5)	30 (63.8)	23 (62.2)
IIEF-5 (mean±SD)	16.7±4.3	13.8±6.9	13.4±5.3	11.5±7.1
Risk factors
Smoking	44 (68.8)	45 (67.2)	49 (70.0)	34 (62.9)
Overweight(BMI>25)	30 (46.9)	34 (50.7)	34 (48.6)	22 (40.7)
Hypertension (BP>140/90mmHg)	48 (75.0)	42 (62.7)	46 (65.7)	37 (68.5)
Age (≥65 years)	22 (34.4)	21 (31.3)	26 (37.1)	29 (53.7)
DM (FBS>140mg/dl)	8 (12.5)	15 (22.4)	17 (24.3)	10 (18.5)
Hyperlipidemia (total cholesterol ≥200mg/dl)	14(21.9)	20 (29.9)	26 (37.1)	13 (24.1)
No. of risk factors
No	2(3.1)	1 (1.5)	0 (0.0)	0 (0.0)
Single	2(3.1)	9 (13.4)	9 (12.9)	11 (20.4)
Double	27 (42.3)	19 (28.4)	17 (24.3)	12 (22.2)
Triple	23 (35.9)	23 (34.3)	25 (35.7)	18(33.3)
More than quadruple	10 (15.6)	15 (22.4)	19 (27.1)	13 (24.1)

ED: erectile dysfunction, CAD: coronary artery disease, CAG: coronary angiography, Fx.: finding, VD: vessel disease, IIEF-5: 5-item Version the International Index of Erectile Function, BMI: body mass index, BP: blood pressure, DM: diabetes mellitus, FBS: fasting blood sugar

Table 4.

Multivariate analysis of the accompanying cardiovascular risk factors for ED according to the CAG results in patients with CAD

Variables	ED
Variables	OR	95% CI	p-value
Non specific Fx. on CAG
Smoking	0.36	0.09-1.41	0.142
Overweight(BMI>25)	0.56	0.15-2.06	0.385
Hypertension (BP> 140/90mmHg)	0.83	0.20-3.44	0.794
Age (≥65 years)	13.75	3.45-54.87	< 0.001
DM (FBS>140mg/dl)	1.48	0.24-9.05	0.672
Hyperlipidemia (total cholesterol > 200mg/dl)	1.76	0.39-7.90	0.462
One VD
Smoking	0.38	0.11-1.29	0.122
Overweight(BMI>25)	1.37	0.48-3.92	0.559
Hypertension (BP> 140/90mmHg)	1.06	0.35-3.26	0.918
Age (≥65 years)	2.33	0.69-7.84	0.174
DM (FBS>140mg/dl)	1.27	0.35-4.55	0.715
Hyperlipidemia (total cholesterol > 200mg/dl)	1.29	0.40-4.06	0.684
Two VD
Smoking	0.35	0.08-1.46	0.149
Overweight(BMI>25)	1.01	0.31-3.36	0.982
Hypertension (BP> 140/90mmHg)	0.74	0.20-2.72	0.656
Age (≥65 years)	5.75	1.48-22.40	0.012
DM (FBS>140mg/dl)	12.78	1.40-107.72	0.024
Hyperlipidemia (total cholesterol > 200mg/dl)	2.24	0.62-8.06	0.218
Three VD
Smoking	0.32	0.07-1.43	0.137
Overweight(BMI>25)	0.71	0.18-2.89	0.635
Hypertension (BP> 140/90mmHg)	0.97	0.22-4.23	0.964
Age (≥65 years)	6.02	1.46-24.92	0.013
DM (FBS>140mg/dl)	1.59	0.26-9.80	0.617
Hyperlipidemia (total cholesterol > 200mg/dl)	6.44	0.93-44.72	0.049

ED: erectile dysfunction, CAD: coronary artery disease, OR: odds ratio, CI: confidence interval, Fx.: finding, CAG: coronary angiography, VD: vessel disease, BMI: body mass index, BP: blood pressure, DM: diabetes mellitus, FBS: fasting blood sugar

Table 5.

Multivariate analysis of the accompanying cardiovascular risk factors for ED in patients with CAD

Variables	Multivariable logistic regression
Variables	OR	95% CI	p-value
Smoking	0.40	0.21-0.74	0.004
Overweight(BMI>25)	0.92	0.53-1.62	0.777
Hypertension (BP>140/90mmHg)	0.83	0.45-1.54	0.559
Age (≥65 years)	5.63	3.00-10.56	< 0.001
DM (FBS>140mg/dl)	2.53	1.19-5.38	0.016
Hyperlipidemia (total cholesterol > 200mg/dl)	2.03	1.07-3.83	0.02

ED: erectile dysfunction, CAD: coronary artery disease, OR: odds ratio, CI: confidence interval, BMI: body mass index, BP: blood pressure, DM: diabetes mellitus, FBS: fasting blood sugar

Table 6.

Analysis of the relationship of ED to various medications in patients with CAD

Variable	ED		chi-square test		Multivariable logistic regression
Variable	No(%)	Yes (%)	p-value	OR	95% CI	p-value
α-blockers
No	90 (35.3)	139 (54.5)
Yes	13(5.1)	13(5.1)	0.292	0.64	0.26-1.55	0.322
β-blockers
No	78 (30.6)	92 (36.1)
Yes	25 (9.8)	60 (23.5)	0.012	1.93	1.04-3.56	0.037
Diuretics
No	69 (27.1)	79 (31.0)
Yes	34 (13.3)	73 (28.6)	0.017	2.23	1.25-3.95	0.006
Ca.-Ch. blockers∗
No	63 (24.7)	88 (34.5)
Yes	40 (15.7)	64 (25.1)	0.602	1.46	0.82-2.60	0.202
ACE inhibitors^†
No	46 (18.0)	76 (29.8)
Yes	57 (22.4)	76 (29.8)	0.402	0.94	0.55-1.61	0.815
Ang.-II R. antagonists^‡
No	72 (28.2)	113(44.3)
Yes	31 (12.2)	39 (15.3)	0.436	0.98	0.52-1.85	0.940
Nitrates
No	52 (20.4)	66 (25.9)
Yes	51 (20.0)	86 (33.7)	0.267	1.69	0.96-2.96	0.068

ED: erectile dysfunction, OR: odd ratio, CI: confidence interval, ED: erectile dysfunction, ∗Ca.-Ch. blockers: calcium-channel blockers, ^† ACE inhibitors: angiotensin converting enzyme inhibitors, ^‡Ang.-II R. antagonists: angiotensin-II receptor antagonists

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