Author + information
- Received June 18, 2007
- Revision received October 9, 2007
- Accepted October 15, 2007
- Published online May 27, 2008.
- Carmine Gazzaruso, MD, PhD⁎,⁎ (, )
- Sebastiano B. Solerte, MD†,
- Arturo Pujia, MD§,
- Adriana Coppola, RN, MS⁎,
- Monia Vezzoli, MD⁎,
- Fabrizio Salvucci, MD⁎,
- Cinzia Valenti, MD⁎,
- Andrea Giustina, MD∥ and
- Adriana Garzaniti, MD‡
- ↵⁎Reprint requests and correspondence:
Dr. Carmine Gazzaruso, Clinical Institute “Beato Matteo,” Via Aselli, 5, 27100 Pavia, Italy.
Objectives We sought to investigate whether erectile dysfunction (ED) is a predictor of future cardiovascular events and death in diabetic patients with silent coronary artery disease (CAD) and whether there are predictors of cardiovascular events and death among CAD diabetic patients with ED.
Background Case-control studies showed that ED is associated with CAD in diabetic patients, but no prospective study is available.
Methods Type 2 diabetic men (n = 291) with silent CAD angiographically documented were recruited. Erectile dysfunction was assessed by the International Index Erectile Function-5 questionnaire.
Results During a follow-up period of 47.2 ± 21.8 months (range 4 to 82 months), 49 patients experienced major adverse cardiac events (MACE). The difference in ED prevalence between patients with and those without MACE was significant (61.2% vs. 36.4%; p = 0.001). Cox regression analysis showed that ED predicted MACE (hazard ratio [HR] 2.1; 95% confidence interval [CI] 1.6 to 2.6; p < 0.001). Among patients with CAD and ED, the Kaplan-Meier method showed that the statin (Mantel log-rank test: 3.921; p = 0.048) and 5-phosphodiesterase (5-PDE) inhibitor use (Mantel log-rank test: 4.608; p = 0.032) were associated with a lower rate of MACE. Cox regression analysis showed that statin use (HR 0.66; 95% CI 0.46 to 0.97; p = 0.036) reduced MACE. Treatment with 5-PDE inhibitors did not enter the model, but its p value was very near to the significant level (HR 0.68; 95% CI 0.46 to 1.01; p = 0.056).
Conclusions Our data first show that ED is a powerful predictor of cardiovascular morbidity and mortality in diabetic patients with silent CAD and that the treatment with statins and 5-PDE inhibitors might reduce the occurrence of MACE among CAD diabetic patients with ED.
- Received June 18, 2007.
- Revision received October 9, 2007.
- Accepted October 15, 2007.
- American College of Cardiology Foundation