Abstract 3351: Erectile Dysfunction Predicts Peripheral Arterial Disease as Measured by Screening Ankle Brachial Index Testing
Background: Peripheral arterial disease (PAD) as determined by ankle brachial index (ABI) testing is a potent marker of adverse cardiovascular prognosis, yet PAD frequently remains asymtomatic or undiagnosed. Erectile dysfunction (ED) has been associated with subclinical atherosclerotic vascular disease, but whether ED is a marker for occult or aysmtomatic PAD is unknown. We hypothesized that ED is a marker for previosuly undiagnosed PAD, and thus ED may identify men who would benefit from screening ABI testing.
Methods: As part of a prospective data collection, 465 men referred for stress testing were screened for ED and PAD, using the validated international index of erectile function (IIEF), and ABI evaluation, respectively. Men with prior documented PAD were excluded. ED was defined by a score of ≤ 25 on the IIEF, with ED severity (mild = 22–25, moderate = 17–21 , severe ≤ 16) also noted. PAD was defined as a ABI ≤ 0.9. Cardiovascular comorbidities and symptoms of PAD were recorded.
Results: ED was present in 50% of pts and PAD was present in 18%. Of pts found to have PAD, 69% reported no lower extremity symptoms. Men with ED were found to have significantly more PAD than men without ED (22% vs 13%, p<0.01), and there was a stepwise increase in the prevalence of PAD with increasing ED severity (27% among men with ≥ moderate ED, 35% among men wiht severe ED, both p<0.01 compared to men without ED). On multivariate logistic regression analysis considering age, HTN, diabetes, tobacco use, hypercholesterolemia, and prior coronary artery disease, any ED (OR 1.7, 95% CI 1.0–2.8, p=0.04), ≥ moderate ED (OR 2.1 95% CI 1.3–3.5, p<0.01), and severe ED (OR 3.0 95% CI 1.7–5.0, p<0.001), were found to be increasingly strong independent predictors of PAD.
Conclusions: Among men referred for stress testing, ED is an independent predictor of occult PAD as determined by screening ABI testing, and increasing severity of ED is associated with increasing prevalence of PAD. These results suggest that men with ED should be targeted for screening ABI evaluation. Whether men with ED experience a similarly adverse cardiovascular prognosis as PAD pts deserves futher study.