Association between Coronary Artery Disease and Erectile Dysfunction in Patients of a University Hospital

Author(s): Nicole Favretto Baltazar, Carolina Dario Fischer, Stefanie Basilio Medeiros, Paola Beatriz Souza Ferrés, Luis Cesar Fava Spessoto, Moacir Fernandes de Godoy, Fernando Nestor Facio Junior

Background: Over the last decade, male sexual dysfunction has become a topic of great interest to clinicians, researchers and to public health managers. Many chronic coronary artery disease patients in Brazil suffer from erectile dysfunction (ED) and most do not feel comfortable about reporting their complaints. One of the main protection mechanisms against the onset and progression of cardiovascular diseases is physical activity. The objective of this study was to investigate the association between coronary artery disease and the degree of ED in a university hospital, as well as its relationship with age and modifiable risk factors such as low levels of physical activity and smoking. Methods: Sixty-seven patients with coronary artery disease were evaluated at a university hospital in a cross-sectional observational study using the International Index of Erectile Function (IIEF) questionnaire. Results: No association was found for the degree of ED with coronary artery disease, physical exercise or smoking. However, the results of this questionnaire showed that 79% these patients had some degree of ED. Conclusions: In this study, no association was found between patients with coronary artery disease and the degree of ED but, at a cut-off point of 21, the IIEF was very sensitive to indicate the presence of concomitant coronary artery disease.

Coronary Artery Disease, Erectile Dysfunction, Physical Activity, Smoking

1. Montorsi P, Ravagnani PM, Vlachopoulos C. Clinical significance of erectile dysfunction developing after acute coronary event: exception to the rule or confirmation of the artery size hypothesis? Asian J Androl 2015;17(1):21-5.
2. Melman A. Evaluation and management of erectile dysfunction. Surg Clin North Am 1988;68(5):965-81.
3. Mulcahy JJ. Current approach to the treatment of penile implant infections. Ther Adv Urol 2010;2(2):69-75.
4. Dzenkeviciute V, Petrulioniene Z, Sapoka V, Kasiulevicius V. Association between erectile dysfunction and asymptomatic cardiovascular damage in middle-aged men. Medicina (Kaunas) 2013;49(12):510-6.
5. Gandaglia G, Salonia A, Passoni N, Montorsi P, Briganti A, Montorsi F. Erectile dysfunction as a cardiovascular risk factor in patients with diabetes. Endocrine 2013;43(2):285-92.
6. Kapur V, Schwarz ER. The relationship between erectile dysfunction and cardiovascular disease. Part I: pathophysiology and mechanisms. Rev Cardiovasc Med 2007;8(4):214-9.
7. Sivalingam S, Hashim H, Schwaibold H. An overview of the diagnosis and treatment of erectile dysfunction. Drugs 2006;66(18):2339-55.
8. El-Sakka AI, Morsy AM, Fagih BI. Severity of erectile dysfunction could predict left ventricular diastolic dysfunction in patients without overt cardiac complaint. J Sex Med 2011;8(9):2590-7.
9. Francavilla S, Bocchio M, Pelliccione F, Necozione S, Francavilla F. Vascular aetiology of erectile dysfunction. Int J Androl 2005;28 Suppl 2:35-9.
10. El-Sakka AI, Morsy AM, Fagih BI, Nassar AH. Coronary artery risk factors in patients with erectile dysfunction. J Urol 2004;172(1):251-4.
11. Gazzaruso C, Giordanetti S, De Amici E, Bertone G, Falcone C, Geroldi D, et al. Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation 2004;110(1):22-6.
12. Brunner H, Cockcroft JR, Deanfield J, Donald A, Ferrannini E, Halcox J, et al. Endothelial function and dysfunction. Part II: Association with cardiovascular risk factors and diseases. A statement by the Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension. J Hypertens 2005;23(2):233-46.
13. Fernandes-Maia ACS, Pinheiro FP, Arruda JGF, Spessoto LCF, Arrruda PFF, Fácio Jr FN. Cardiovascular risk factors in patients with erectile dysfunction. Int J Sci 2016;5(2):32-37.
14. Spessoto LC, Facio FN Jr, de Arruda JG, Arruda PF, Gatti M, Antoniassi TS, et al. Association of hypertension with erectile function in chronic peripheral arterial insufficiency patients. J Clin Med Res 2016;8(8):582-4.
15. Pinheiro FP, Fernandes-Maia ACS, Arruda JGF, Spessoto LCF, Arrruda PFF, Fácio Jr FN. Relationship between sedentary lifestyle and erectile dysfunction. Int J Sci 2015;4(12):68-72.
16. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erecile Functile Function (IIEF-5) as a diagnostic tool for erecile dysfunction. Int J Impot Res 1999;11(6):319-26.
17. Nunes SOV, Vargas HO, Nunes LVA, Noto MVN. A dependência do tabaco. In Nunes SOV and Castro MRP., orgs. Tabagismo: abordagem, prevenção e tratamento [online]. Londrina: EDUEL, 2011. pp. 41-54.
18. 18. Mulhall J, Teloken P, Brock G, Kim E. Obesity, dyslipidemias and erectile dysfunction: a report of a subcommittee of the sexual medicine society of North America. J Sex Med 2006;3(5):778-86.
19. Montorsi P, Ravagnani PM, Galli S, Rotatori F, Veglia F, Briganti A, et al. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J 2006;27(22):2632-9.
20. Sekoranja L, Bianchi-Demicheli F, Gaspoz JM, Mach F. [Erectile dysfunction: a potential useful marker for cardiovascular disease]. Rev Med Suisse 2006;2(58):774-6, 78.
21. Gupta BP, Murad MH, Clifton MM, Prokop L, Nehra A, Kopecky SL. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med 2011;171(20):1797-803.
22. Canat L, Cicek G, Atis G, Gurbuz C, Caskurlu T. Is there a relationship between severity of coronary artery disease and severity of erectile dysfunction? Int Braz J Urol 2013;39(4):465-73.
23. Hackett G., Krychman M., Baldwin D, Bennett N, El-Zawahry A, Graziottin A, et al. Coronary heart disease, diabetes, and sexuality in men. J Sex Med 2016;13(6): 887-904.
24. Moreira ED Jr, Abdo CH, Torres EB, Lobo CF, Fittipaldi JA. Prevalence and correlates of erectile dysfunction: results of the Brazilian study of sexual behavior. Urology 2001;58(4):583-8
25. Moreira ED Jr, Bestane WJ, Batolo EB, Fittipaldi JA. Prevalence and determinants of erectile dysfunction in Santos, Southeastem Brazil. São Paulo Med J 2002;120(2):49-54.
26. Sai Ravi Shanker A, Phanikrishna B, Bhaktha Vatsala Reddy C. Association between erectile dysfunction and coronary artery disease and its severity. Indian Heart J 2013;65(2):180-6.
27. Salem S, Abdi S, Mehrsai A, Saboury B, Saraji A, Shokohideh V, et al. Erectile dysfunction severity as a risk predictor for coronary artery disease. J Sex Med 2009;6(12):3425-32.
28. Ortiz J, Ortiz ST, Monaco CG, Yamashita CH, Moreira MC, Monaco CA. [Erectile dysfunction: a marker for myocardial perfusion impairment?]. Arq Bras Cardiol 2005;85(4):241-6.