title: Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients.
abstract: BACKGROUND
  Erectile dysfunction (ED) is associated with coronary artery disease (CAD). In diabetic patients, CAD is often silent. Among diabetic patients with silent CAD, the prevalence of ED has never been evaluated. We investigated whether ED is associated with asymptomatic CAD in type 2 diabetic patients.
  
  
  RESULTS
  We evaluated the prevalence of ED in 133 uncomplicated diabetic men with angiographically verified silent CAD and in 127 diabetic men without myocardial ischemia at exercise ECG, 48-hour ambulatory ECG, and stress echocardiography. The groups were comparable for age and diabetes duration. Patients were screened for ED using the validated International Index of Erectile Function (IIEF-5) questionnaire. The prevalence of ED was significantly higher in patients with than in those without silent CAD (33.8% versus 4.7%; P=0.000). Multiple logistic regression analysis showed that ED, apolipoprotein(a) polymorphism, smoking, microalbuminuria, HDL, and LDL were significantly associated with silent CAD; among these risk factors, ED appeared to be the most efficient predictor of silent CAD (OR, 14.8; 95% CI, 3.8 to 56.9).
  
  
  CONCLUSIONS
  Our study first shows a strong and independent association between ED and silent CAD in apparently uncomplicated type 2 diabetic patients. If our findings are confirmed, ED may become a potential marker to identify diabetic patients to screen for silent CAD. Moreover, the high prevalence of ED among diabetics with silent CAD suggests the need to perform an exercise ECG before starting a treatment for ED, especially in patients with additional cardiovascular risk factors.
authors.affiliation: Internal Medicine Unit, IRCCS Maugeri Foundation Hospital, Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy. c.gazzaruso@tele2.it
authors.forename: Carmine
authors.initials: C
authors.lastname: Gazzaruso
authors.forename: Stefano
authors.initials: S
authors.lastname: Giordanetti
authors.forename: Emanuela
authors.initials: E
authors.lastname: De Amici
authors.forename: Gianandrea
authors.initials: G
authors.lastname: Bertone
authors.forename: Colomba
authors.initials: C
authors.lastname: Falcone
authors.forename: Diego
authors.initials: D
authors.lastname: Geroldi
authors.forename: Pietro
authors.initials: P
authors.lastname: Fratino
authors.forename: Sebastiano B
authors.initials: SB
authors.lastname: Solerte
authors.forename: Adriana
authors.initials: A
authors.lastname: Garzaniti
mesh_terms: D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D007172:Erectile Dysfunction / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis; D015995:Prevalence; D011859:Radiography