Prevalence and Clinical Severity of Erectile Dysfunction in Patients Undergoing Coronary Angiography: A Descriptive Cross-Sectional Study at a Tertiary Hospital in Northern Sri Lanka

BACKGROUND

Erectile dysfunction (ED) is an early clinical manifestation, and it could also be the "tip of the iceberg" of chronic atherosclerotic disease. As the onset of ED precedes major cardiovascular events, screening for it could be a simple and cost-effective approach for preventive management in low-income countries like Sri Lanka. This study aimed to determine the prevalence and clinical severity of ED among male patients undergoing coronary angiography, to assess the association between ED severity and the extent of coronary artery disease (CAD), and to examine relevant clinical risk factors.

METHODS

A descriptive cross-sectional study was conducted among male patients undergoing coronary angiography at Teaching Hospital Jaffna, Sri Lanka, from July 2024 to October 2024. All eligible patients were recruited, which represents 73.9% (298) of the estimated sample. A structured interviewer-administered form was utilized to collect the data, which included a validated International Index of Erectile Function (IIEF)-5 questionnaire for assessing ED. Coronary angiography findings were used to assess the severity of CAD. IBM SPSS Statistics for Windows, Version 29 (Released 2021; IBM Corp., Armonk, New York, United States) was used to analyze the data.

RESULTS

Out of 298 male patients who underwent coronary angiography during the study period, 181 were found to have ED (60.7%; CI: 55.1-66.2). There was a statistically significant association between ED severity and CAD extent (p-value < 0.001), particularly notable in patients with multi-vessel disease. The proportion of patients with severe ED (IIEF index = 4) showed an increased number of affected coronary vessels. Among patients with triple vessel disease, 82.5% (52 out of 63) had severe ED, while in patients with single-vessel disease and normal epicardial coronary vessels, severe ED was much less prevalent (5.7% and 4.9%, respectively) (Spearman-correlation r = 0.637, p-value < 0.001). The presence of hypertension was significantly associated with ED (p-value = 0.026) as well as the duration of hypertension (p-value = 0.034) in bivariate analysis. After adjustment for potential confounders, the results showed that diagnosed CAD was associated with a 3.92 times (CI: 2.2-7.03) higher risk of having ED.

CONCLUSION

This study demonstrated a strong association between ED and CAD, and it highlights that ED is an early indicator of underlying CAD. Routine screening for ED in high-risk patients, particularly those with hypertension and diabetes, can improve early detection of CAD and aid in the implementation of preventive strategies. However, the study's limitations, including its single-center design and cross-sectional nature, highlight the need for further multi-center and longitudinal research to validate these findings and explore the potential therapeutic benefits of ED management in cardiovascular disease.

Prevalence of Asymptomatic Coronary Artery Stenosis Based on Coronary Computed Tomography Angiography in Adults with Erectile Dysfunction: A Cross-Sectional Study

OBJECTIVES

To investigate the prevalence of asymptomatic coronary artery stenosis (CAS) using coronary computed tomography angiography (CCTA) in Korean men with erectile dysfunction (ED).

SUBJECTS AND METHODS

A cross-sectional study was conducted on 108 men who underwent CCTA at a health promotion center in Pusan National University Yangsan Hospital. Each subject who was evaluated for ED using the International Index of Erectile Dysfunction (IIEF) questionnaire did not have a past history or symptoms of coronary artery disease (CAD). We assessed the association between ED and CCTA-based CAS.

RESULTS

The overall prevalence of ED was 57.4%; furthermore, age (p = 0.001) and fasting blood glucose (p =0.035) were the metabolic risk factors that were most significantly associated with the presence of ED. The overall frequency of CAS was 31.5%, and ED (p = 0.022), age (p < 0.001), fasting blood glucose (p = 0.021), and total cholesterol/high-density lipoprotein cholesterol (p = 0.029) were significantly associated with the presence of CAS. The prevalence of CAS was 40.3 and 19.6% in the ED and non-ED groups, respectively. Men with ED were 2.778 times more likely to present with CAS than those without ED (OR 2.778, 95% CI 1.143-6.749, p = 0.024); however multivariate logistic regression analysis, while controlling for age, total cholesterol/high-density lipoprotein cholesterol, and fasting blood glucose, suggested the absence of a significant association between ED and CCTA-based CAS.

CONCLUSION

This study shows that CCTA-based CAS is a common phenomenon in men who have ED. Furthermore, ED patients without cardiac symptoms need to be investigated for the possibility of hidden CAD.

Efficacy and Safety of Tadalafil 5 mg Administered Once Daily in Korean Men with Erectile Dysfunction: A Prospective, Multicenter Study

PURPOSE

The aim of this study was to evaluate the efficacy of a daily dose of tadalafil 5 mg as well as its safety for the cardiovascular system in men with erectile dysfunction.

MATERIALS AND METHODS

This study included a total of 162 men who were administered a daily dose of tadalafil 5 mg between April and December of 2009. A total of 127 men completed the 8-week clinical trial. The International Index of Erectile Function (IIEF)-5, blood pressure, and heart rate were measured before treatment with tadalafil (V1) and 4 (V2) and 8 weeks (V3) after treatment with tadalafil. Adverse effects were assessed at V1, V2, and V3. In cases in which the International Prostate Symptom Score (IPSS) was ≥8 at V1, maximal flow rate (Qmax) and postvoid residual volume (PVR) were measured.

RESULTS

The IIEF-5 values were 11.25±3.18, 14.56±3.79, and 16.91±3.56 at V1, V2, and V3, respectively, with significant improvement (V1 vs. V2, p<0.001; V1 vs. V3, p<0.001). The IPSS values were 10.59±5.56, 9.07±6.06, and 8.15±6.10 at V1, V2, and V3, respectively, and the differences were statistically significant (V1 vs. V2, p<0.001; V1 vs. V3, p<0.001). There were no significant differences in blood pressure or heart rate. Adverse effects were observed in 7 men (5.51%) at V2 and in 5 men (3.94%) at V3.

CONCLUSIONS

Tadalafil 5 mg administered once-a-day may be effective in improving erectile function. Adverse effects on the cardiovascular system may be minimal. In addition, it is believed that this may also be effective in improving voiding symptoms.