Erectile dysfunction as a predictor of asymptomatic coronary artery disease in elderly men with type 2 diabetes

Association of erectile dysfunction with coronary artery disease in Type 2 Diabetes mellitus

Objectives

Association of severity of Erectile Dysfunction (ED) and coronary artery disease (CAD) in type 2 diabetics based on the number of vessels involved.

Design

an observational, cross-sectional study.

Setting

tertiary level health care centre.

Participants

104 diabetics, as defined by ADA(American Diabetes Association) criteria, who fulfilled the inclusion criteria of positive coronary angiogram (in the last six months), were selected to participate in the study after obtaining informed consent. Details regarding ED were obtained using the IIEF-5 questionnaire, and based on their scores, participants were divided into four categories ranging from mild to severe.

Interventions

use of questionnaire International Index of Erectile Function-5.

Main outcome measures

Karl Pearson association was done between the number of major coronary vessels involved and the severity of ED. The receiver operating characteristic curve was plotted between ED status and coronary vessels involved to predict the cut-off limit of ED score to predict CAD.

Results

Out of 104 diabetics with CAD, 85.5% gave a history of ED. Most participants had mild to moderate degrees of ED, which was reported as occurring 4-6 years before the diagnosis of CAD. Cross tabulation between the severity of ED and association with the number of coronary vessels involved found no statistically significant association (p>0.05). However, ROC analysis showed sufficient accuracy in predicting the severity of CAD.

Conclusion

The presence of ED in diabetic patients warrants screening for cardiovascular disease. A clear association between the severity of ED and the number of coronary vessels involved is still questionable.

Funding

None declared.

Transmucosal oxygen tension of the clitoris: a new parameter for future investigations of the sexual, metabolic, and cardiovascular health of women

BACKGROUND

Several studies suggested that abnormalities in tissue perfusion of external genitalia and vagina can lead to female sexual dysfunctions (FSDs) and can be associated to metabolic and cardiovascular risk factors. However, there are some technical difficulties in assessing these abnormalities. The measurement of oxygen partial pressure is a noninvasive method to measure oxygen partial pressure (pO₂) at the skin surface to assess tissue perfusion. The aim of this study was to evaluate whether transmucosal oxygen tension (TmPO₂) can be measured at the mucosal surface of clitoris and whether the measurements are reliable.

METHODS

TmPO₂ was measured in six young healthy women by using a device to measure transcutaneous pO₂ on the skin and by choosing a small sensor, usually used for newborns. The identical procedure for the detection of pO₂ at the skin surface was used.

RESULTS

The mean value of TmPO₂ was 42.3 mmHg (range: 24.1-53.4 mmHg). All the trend curves of the TmPO₂ showed the same behavior: after a stabilization time, there was a stable pO₂ (plateau phase) that corresponds to the TmPO₂ of the clitoris. These curves had a similar trend to those recorded at the skin surface.

CONCLUSIONS

TmPO₂ can be easily measured at the mucosal surface of clitoris. Large epidemiological studies in healthy and unhealthy women and in women with FSD are needed to establish both the normal range of TmPO₂ and the meaning that different values of TmPO₂ can have on sexual and general health of the women.

Erectile dysfunction severity as a predictor of left main and/or three-vessel disease in acute coronary syndrome patients

BACKGROUND

Coronary artery disease (CAD) is a leading cause of morbidity and death. Early diagnosis of patients with left main and/or three-vessel disease (LM/3VD) among acute coronary syndrome (ACS) patients is beneficial. The relation between erectile dysfunction (ED) and cardiovascular diseases was previously noticed. The aim of our work was to find out if the severity of ED could predict the presence of LM/3VD in ACS patients.

PATIENTS AND METHODS

Eighty-five male patients with ACS were included in the study. Clinical assessment, estimation of international index of erectile function (IIEF) score, and coronary angiography were performed in all patients. Gensini score was calculated to assess the severity of CAD. Based on IIEF score, the patients were divided into two groups: Group 1: patients with mild or no ED (IIEF score ≥17), Group 2: patients with moderate or severe ED (IIEF score <17).

RESULTS

Patients with IIEF score <17 had significantly higher prevalence of LM CAD (4.3% versus 18.4%, p=0.035), 3VD (17% versus 39.5%, p=0.021) and LM/3VD (21.3% versus 55.3%, p=0.0012), as well as higher mean Gensini score (23.5±10.8 versus 34.1±12.7, p=0.0001). The independent predictors of LM/3VD in order of significance were: age, heart rate, IIEF <17, Killip class >1, and ST-depression or ST-elevation in lead aVR ≥1mV. There was a significant negative correlation between IIEF score and Gensini score (r=-0.383, p=0.0003).

CONCLUSION

The presence of moderate or severe ED in men with ACS is associated with higher Gensini score and more incidence of LM/3VD. IIEF score <17 was an independent predictor of LM/3VD.