Erectile dysfunction and asymptomatic coronary artery disease: frequently detected by computed tomography coronary angiography but not by exercise electrocardiography

AimsErectile dysfunction (ED) and vascular disease, in particular coronary artery disease (CAD), have the common denominator of endothelial dysfunction. ED frequently precedes a CAD event by between 2 and 5years (average 3years). ED also predicts an acute coronary syndrome as well as increased mortality, suggesting the rupture of an asymptomatic coronary plaque. This study compares multi-detector cardiac computed tomography (MDCT) with maximal treadmill exercising in men with ED and no coronary symptoms as a means of detecting coronary lesions. MethodsSixty-five men with organic ED and no cardiac symptoms were prospectively screened for CAD. All underwent maximal exercise testing and MDCT in the same 7-day period. The Sexual Health Inventory for Men questionnaire established the presence of ED. FindingsThe exercise ECG was borderline abnormal in three men and normal in 62. CT calcium was present in 53 (score 5-1671) and non-calcified plaque in seven. The MDCT angiogram was normal in only 5 (3.25%). ConclusionErectile dysfunction may predict CAD in the absence of cardiac symptoms. MDCT detects subclinical plaque which may be vulnerable to rupture and which is not flow limiting enough to influence the exercise ECG. The window of 2-5years between ED and a CAD event offers an opportunity for aggressive risk factor reduction. ED should be a routine question in any risk calculator.