Erectile dysfunction as a cardiovascular risk factor in patients with diabetes
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REVIEW
Erectile dysfunction as a cardiovascular risk factor in patients with diabetes Giorgio Gandaglia • Andrea Salonia • Niccolo` Passoni • Piero Montorsi • Alberto Briganti • Francesco Montorsi
Received: 10 August 2012 / Accepted: 22 August 2012 / Published online: 5 September 2012 Ó Springer Science+Business Media, LLC 2012
Abstract Erectile dysfunction (ED) is a highly prevalent disorder among patients with diabetes mellitus (DM). In most cases, ED is considered a vascular disease and its development is significantly related to the exposure to CVD risk factors. In this context, ED and coronary artery disease (CAD) have been proposed as different manifestations of the same systemic disease; in nondiabetic patients, ED has progressively emerged as an important sentinel marker of the subsequent onset of CVD events. The aim of this review was to evaluate the association between ED and CAD in diabetic patients and to evaluate the role of ED as an independent CVD risk factor in these patients. Three large prospective studies confirmed that ED is a powerful predictor of CAD and cardiac mortality in patients with DM. Overall, diabetic patients with ED had roughly 1.4-fold higher risk of CAD as compared with those without ED. Interestingly, in diabetic patients, CAD is often silent and CAD screening according to the current guidelines can miss up to 40 % patients with occult myocardial perfusion abnormalities. Indeed, patients with ED have higher risk of silent myocardial ischemia compared to those without ED, and when ED is added to the risk factors, G. Gandaglia A. Salonia N. Passoni A. Briganti Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, University Vita–Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy e-mail: [email protected] P. Montorsi Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy F. Montorsi (&) Department of Urology, University Vita–Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy e-mail: [email protected]
it can even improve the sensitivity of screening for asymptomatic CAD. Therefore, ED should be considered an independent CVD risk factor, and it could improve the identification of diabetic patients suitable for screening, leading to an early detection of CAD, and thus potentially enhancing the therapeutic effectiveness. Keywords Erectile dysfunction Diabetes Coronary artery disease
Introduction Erectile dysfunction (ED) is defined as the recurrent or consistent inability to obtain and/or maintain a penile erection sufficient for satisfactory sexual performance [1]. These symptoms must be present for at least 3 months before a diagnosis can be made [2]. Erectile dysfunction is a common disorder and its incidence increases with age [3]. Several studies reported that the prevalence of ED ranged from 2 to 9 % in the decade from 40 to 49, increasing to a rate of 20–40 % for the ages 60–69 years and reaching a higher prevalence in men in their 70 and 80s. Indeed, thro
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