Iranian Journal of Medical Sciences

Document Type : Original Article(s)

Authors

1 Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

2 Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

3 Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran

10.30476/ijms.2024.100731.3312

Abstract

Background: Erectile dysfunction (ED) is associated with cardiovascular events, and a significant proportion of men with coronary artery disease (CAD) exhibit early signs of ED. Moreover, both of these disorders shared common risk factors in previous studies. This study was conducted to determine which risk factors and conditions in CAD patients might contribute to the occurrence of ED.
Methods: This analytical cross-sectional study was conducted in the North of Iran from October 2016 to September 2017. 316 patients with coronary artery disease were enrolled. Demographic information were collected using a checklist, and the International Index of Erectile Function (IIEF-15) questionnaire  was used to determine the participant’s ED status. Univariate and multivariate logistic regression were used to investigate associated factors.
Results: The mean age of the participants was 56.51±9.88 years. About 55.1% of the patients had ED. Moreover, the severity of CAD was independently associated with an increased risk of ED (OR=4.11, 95%CI=1.69-9.97), with patients having more than one involved coronary artery and greater coronary artery stenosis had a higher risk of developing ED occurrence (OR=3.74, 95%CI=1.72-8.09). Besides, age (OR=1.23, 95%CI=1.18-1.29) and BMI (OR=1.26, 95%CI=1.13-1.41) were independent predictors of ED occurrence in CAD patients. 
Conclusion: Higher CAD severity, older age, and higher BMI were all independent predictors of ED occurrence in CAD patients. While, diabetes mellitus, dyslipidemia, and smoking were not independent risk factors, they could contribute to the development of ED when combined with other risk factors.

Keywords

  1. Buntsma N, van der Pol E, Nieuwland R, Gasecka A. Extracellular Vesicles in Coronary Artery Disease. Adv Exp Med Biol. 2023;1418:81-103. doi: 10.1007/978-981-99-1443-2_6. PubMed PMID: 37603274.
  2. Cassar A, Holmes DR, Jr., Rihal CS, Gersh BJ. Chronic coronary artery disease: diagnosis and management. Mayo Clin Proc. 2009;84:1130-46. doi: 10.4065/mcp.2009.0391. PubMed PMID: 19955250; PubMed Central PMCID: PMCPMC2787400.
  3. Hanif MK, Fan Y, Wang L, Jiang H, Li Z, Ma M, et al. Dietary Habits of Patients with Coronary Artery Disease: A Case-Control Study from Pakistan. Int J Environ Res Public Health. 2022;19. doi: 10.3390/ijerph19148635. PubMed PMID: 35886483; PubMed Central PMCID: PMCPMC9318796.
  4. Farsani MK, Sourani M. The effect of a 10-week aerobic exercise on cardiac function among overweight female breast cancer survivors; a randomized clinical trial. Immunopathol Persa. 2023;9:15220. doi: 10.34172/ ipp.2023.15220.
  5. Teimouri K, Khoshgard K, Rouzbahani M, Pakravan S. Cardiac alterations following radiation therapy in individuals with breast cancer. Journal of Renal Endocrinology. 2023;9:e25066. doi: 10.34172/jre.2023.25066.
  6. Wu C, Liu X, Ghista D, Yin Y, Zhang H. Effect of plaque compositions on fractional flow reserve in a fluid-structure interaction analysis. Biomech Model Mechanobiol. 2022;21:203-20. doi: 10.1007/s10237-021-01529-2. PubMed PMID: 34713361.
  7. Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, et al. Erectile dysfunction. Nat Rev Dis Primers. 2016;2:16003. doi: 10.1038/nrdp.2016.3. PubMed PMID: 27188339; PubMed Central PMCID: PMCPMC5027992.
  8. Madani AH, Akhavan A, Madani MH, Farah AS, Esmaeili S, Maroufizadeh S, et al. Evaluation of the frequency of metabolic syndrome and assessment of cardiometabolic index among men with erectile dysfunction: a prospective cross-sectional study. J Diabetes Metab Disord. 2023;22:1191-6. doi: 10.1007/s40200-023-01231-3. PubMed PMID: 37975074; PubMed Central PMCID: PMCPMC10638291.
  9. Irfan M, Ismail SB, Noor NM, Hussain NHN. Efficacy of Aspirin for Vasculogenic Erectile Dysfunction in Men: A Meta-Analysis of Randomized Control Trials. Am J Mens Health. 2020;14:1557988320969082. doi: 10.1177/1557988320969082. PubMed PMID: 33111628; PubMed Central PMCID: PMCPMC7607788.
  10. Dsouza SC, Rahman O. Association of erectile dysfunction with coronary artery disease in Type 2 Diabetes mellitus. Ghana Med J. 2023;57:43-8. doi: 10.4314/gmj.v57i1.7. PubMed PMID: 37576376; PubMed Central PMCID: PMCPMC10416276.
  11. Wang X, Shen Y, Shang M, Liu X, Munn LL. Endothelial mechanobiology in atherosclerosis. Cardiovasc Res. 2023;119:1656-75. doi: 10.1093/cvr/cvad076. PubMed PMID: 37163659; PubMed Central PMCID: PMCPMC10325702.
  12. Sai Ravi Shanker A, Phanikrishna B, Bhaktha Vatsala Reddy C. Association between erectile dysfunction and coronary artery disease and its severity. Indian Heart J. 2013;65:180-6. doi: 10.1016/j.ihj.2013.02.013. PubMed PMID: 23647898; PubMed Central PMCID: PMCPMC3861235.
  13. Imprialos K, Koutsampasopoulos K, Manolis A, Doumas M. Erectile Dysfunction as a Cardiovascular Risk Factor: Time to Step Up? Curr Vasc Pharmacol. 2021;19:301-12. doi: 10.2174/1570161118666200414102556. PubMed PMID: 32286949.
  14. Kalka D, Gebala J, Biernikiewicz M, Mrozek-Szetela A, Rozek-Piechura K, Sobieszczanska M, et al. Erectile Dysfunction in Men Burdened with the Familial Occurrence of Coronary Artery Disease. J Clin Med. 2021;10. doi: 10.3390/jcm10184046. PubMed PMID: 34575155; PubMed Central PMCID: PMCPMC8470252.
  15. Pakpour AH, Zeidi IM, Yekaninejad MS, Burri A. Validation of a translated and culturally adapted Iranian version of the International Index of Erectile Function. J Sex Marital Ther. 2014;40:541-51. doi: 10.1080/0092623X.2013.788110. PubMed PMID: 24308814.
  16. Rosen R. International Index of Erectile Function (LIEF): A multidimensional scale for assessment of erectile dysfunction. Urology. 1997;14:1-28.
  17. Al-Daydamony MM, Shawky A, Tharwat A. Erectile dysfunction severity as a predictor of left main and/or three-vessel disease in acute coronary syndrome patients. Indian Heart J. 2018;70:S56-S9. doi: 10.1016/j.ihj.2018.05.006. PubMed PMID: 30595321; PubMed Central PMCID: PMCPMC6309152.
  18. Hamur H, Duman H, Keskin E, Inci S, Kucuksu Z, Degirmenci H, et al. The relation between erectile dysfunction and extent of coronary artery disease in the patients with stable coronary artery disease. Int J Clin Exp Med. 2015;8:21295-302. PubMed PMID: 26885069; PubMed Central PMCID: PMCPMC4723914.
  19. Baharvand Ahmadi B, Namdari M, Mobarakeh H. Erectile dysfunction as a predictor of early stage of coronary artery disease. J Tehran Heart Cent. 2014;9:70-5. PubMed PMID: 25861322; PubMed Central PMCID: PMCPMC4389195.
  20. Pauker-Sharon Y, Arbel Y, Finkelstein A, Halkin A, Herz I, Banai S, et al. Cardiovascular risk factors in men with ischemic heart disease and erectile dysfunction. Urology. 2013;82:377-80. doi: 10.1016/j.urology.2013.03.034. PubMed PMID: 23769116.
  21. Inman BA, Sauver JL, Jacobson DJ, McGree ME, Nehra A, Lieber MM, et al. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc. 2009;84:108-13. doi: 10.4065/84.2.108. PubMed PMID: 19181643; PubMed Central PMCID: PMCPMC2664580.
  22. Eardley I. The Incidence, Prevalence, and Natural History of Erectile Dysfunction. Sex Med Rev. 2013;1:3-16. doi: 10.1002/smrj.2. PubMed PMID: 27784558.
  23. Moon KH, Park SY, Kim YW. Obesity and Erectile Dysfunction: From Bench to Clinical Implication. World J Mens Health. 2019;37:138-47. doi: 10.5534/wjmh.180026. PubMed PMID: 30079640; PubMed Central PMCID: PMCPMC6479091.
  24. Zhang X, Yang B, Li N, Li H. Prevalence and Risk Factors for Erectile Dysfunction in Chinese Adult Males. J Sex Med. 2017;14:1201-8. doi: 10.1016/j.jsxm.2017.08.009. PubMed PMID: 28874333.
  25. Parmar RS, Verma S, Neelkamal, Pathak VK, Bhadoria AS. Prevalence of erectile dysfunction in Type 2 diabetes mellitus (T2DM) and its predictors among diabetic men. J Family Med Prim Care. 2022;11:3875-9. doi: 10.4103/jfmpc.jfmpc_1130_21. PubMed PMID: 36387626; PubMed Central PMCID: PMCPMC9648286.
  26. Kao YH, Celestin MD, Jr., Walker CD, Yu Q, Couk J, Moody-Thomas S, et al. Smoking Relapse and Type 2 Diabetes Mellitus-Related Emergency Department Visits Among Senior Patients with Diabetes. Prev Chronic Dis. 2019;16:E164. doi: 10.5888/pcd16.190027. PubMed PMID: 31858955; PubMed Central PMCID: PMCPMC6936672.
  27. Bortolotti A, Fedele D, Chatenoud L, Colli E, Coscelli C, Landoni M, et al. Cigarette smoking: a risk factor for erectile dysfunction in diabetics. Eur Urol. 2001;40:392-6. doi: 10.1159/000049805. PubMed PMID: 11713392.