Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with angiographically proven asymptomatic coronary artery disease

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.