title: Erectile dysfunction predicts coronary heart disease in type 2 diabetes.
abstract: OBJECTIVE
  We examined the predictive power of erectile dysfunction (ED) on coronary heart disease (CHD) events in Chinese men with type 2 diabetes.
  
  
  BACKGROUND
  Subjects with diabetes are prone to develop cardiovascular complications. Erectile dysfunction is strongly associated with CHD in cross-sectional studies, but prospective data are lacking.
  
  
  METHODS
  A consecutive cohort of men with no clinical evidence of cardiovascular disease underwent comprehensive assessments for diabetic complications. Erectile dysfunction was defined according to the definition of the National Institutes of Health Consensus Conference 1992. Coronary heart disease events were censored with centralized territory-wide hospital databases in 2005.
  
  
  RESULTS
  Of 2,306 subjects (age: 54.2 +/- 12.7 years; follow-up: 4.0 [range 1.7 to 7.1] years), 26.7% had ED at baseline. The incidence of CHD events was higher in men with ED than those without (19.7/1,000 person-years, 95% confidence interval [CI] 14.3 to 25.2 person-years vs. 9.5/1,000 person-years, 95% CI 7.4 to 11.7 person-years). Men who developed CHD events were older; had a higher frequency of ED and microvascular complications; had longer duration of diabetes; and had higher blood pressure, total cholesterol, low-density lipoprotein cholesterol, and urinary albumin/creatinine ratio but lower high-density lipoprotein cholesterol and estimated glomerular filtration rate than those without CHD events. Erectile dysfunction remained an independent predictor for CHD events (hazard ratio 1.58, 95% CI 1.08 to 2.30, p = 0.018) after adjustment for other covariates along with age, duration of disease, and use of antihypertensive agents and albuminuria.
  
  
  CONCLUSIONS
  In type 2 diabetic men without clinically overt cardiovascular disease, the presence of ED predicts a new onset of CHD events. Symptoms of ED should be independently sought to identify high-risk subjects for comprehensive cardiovascular assessments.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Ronald Ching-Wan
authors.initials: RC
authors.lastname: Ma
authors.forename: Wing-Yee
authors.initials: WY
authors.lastname: So
authors.forename: Xilin
authors.initials: X
authors.lastname: Yang
authors.forename: Linda Wai-Ling
authors.initials: LW
authors.lastname: Yu
authors.forename: Alice Pik-Shan
authors.initials: AP
authors.lastname: Kong
authors.forename: Gary Tin-Choi
authors.initials: GT
authors.lastname: Ko
authors.forename: Chun-Chung
authors.initials: CC
authors.lastname: Chow
authors.forename: Clive Stewart
authors.initials: CS
authors.lastname: Cockram
authors.forename: Juliana Chung-Ngor
authors.initials: JC
authors.lastname: Chan
authors.forename: Peter Chun-Yip
authors.initials: PC
authors.lastname: Tong
mesh_terms: D002681:China; D003327:Coronary Disease / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D007172:Erectile Dysfunction / Q000150:complications*; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology