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(Circulation. 2004;110:22-26.)
© 2004 American Heart Association, Inc.

Original Articles

Relationship Between Erectile Dysfunction and Silent Myocardial Ischemia in Apparently Uncomplicated Type 2 Diabetic Patients

Carmine Gazzaruso, MD; Stefano Giordanetti, MD; Emanuela De Amici, MD; Gianandrea Bertone, MD; Colomba Falcone, MD; Diego Geroldi, MD; Pietro Fratino, MD; Sebastiano B. Solerte, MD; Adriana Garzaniti, MD

From the Internal Medicine Unit, IRCCS Maugeri Foundation Hospital, Department of Internal Medicine and Medical Therapeutics (C.G., S.G., E.D.A., G.B., P.F.), Cardiology Unit (C.F.), Internal Medicine, Vascular and Metabolic Diseases, IRCCS Policlinico San Matteo (D.G.), and the Department of Internal Medicine and Medical Therapeutics (S.B.S.), University of Pavia; and Diabetes Centers of Pavia and Mede (A.G.), Azienda Ospedaliera Province of Pavia, Pavia, Italy.

Correspondence to Carmine Gazzaruso, MD, IRCCS Maugeri Foundation Hospital, Internal Medicine Unit, Via Ferrata 8, 27100 Pavia, Italy. E-mail c.gazzaruso{at}tele2.it

Received September 30, 2003; de novo received December 21, 2003; revision received March 10, 2004; accepted March 17, 2004.

Background— Erectile dysfunction (ED) is associated with coronary artery disease (CAD). In diabetic patients, CAD is often silent. Among diabetic patients with silent CAD, the prevalence of ED has never been evaluated. We investigated whether ED is associated with asymptomatic CAD in type 2 diabetic patients.

Methods and Results— We evaluated the prevalence of ED in 133 uncomplicated diabetic men with angiographically verified silent CAD and in 127 diabetic men without myocardial ischemia at exercise ECG, 48-hour ambulatory ECG, and stress echocardiography. The groups were comparable for age and diabetes duration. Patients were screened for ED using the validated International Index of Erectile Function (IIEF-5) questionnaire. The prevalence of ED was significantly higher in patients with than in those without silent CAD (33.8% versus 4.7%; P=0.000). Multiple logistic regression analysis showed that ED, apolipoprotein(a) polymorphism, smoking, microalbuminuria, HDL, and LDL were significantly associated with silent CAD; among these risk factors, ED appeared to be the most efficient predictor of silent CAD (OR, 14.8; 95% CI, 3.8 to 56.9).

Conclusions— Our study first shows a strong and independent association between ED and silent CAD in apparently uncomplicated type 2 diabetic patients. If our findings are confirmed, ED may become a potential marker to identify diabetic patients to screen for silent CAD. Moreover, the high prevalence of ED among diabetics with silent CAD suggests the need to perform an exercise ECG before starting a treatment for ED, especially in patients with additional cardiovascular risk factors.

Key Words: coronary disease • diabetes mellitus • men • ischemia, silent myocardial • erectile dysfunction

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