title: Erectile dysfunction in patients in a cardiac rehabilitation program.
abstract: OBJECTIVE
  Erectile dysfunction is common in patients with coronary heart disease. The aim of this study was to investigate the incidence of, etiological factors associated with, and treatment results obtained in this condition in patients participating in a cardiac rehabilitation program.
  
  
  METHODS
  The study included 420 male patients with heart disease who were taking part in a multicomponent therapeutic program that involved physical exercise, psychological techniques and risk factor reduction.
  
  
  RESULTS
  Overall, erectile dysfunction was present in 216 patients (52.6%) and there were clear associations with age (P< .001), diabetes mellitus (P< .001), arterial hypertension (P=.029), cigarette smoking (P=.044) and treatment with angiotensin-converting enzyme inhibitors (P=.003) and diuretics (P< .001). However, there were no links to treatment with beta-blockers, calcium antagonists, statins or antiplatelet agents. There were direct associations with trait anxiety (P=.009) and state anxiety (P=.006) and with depression (P=.003). The final multivariate analysis model included diabetes mellitus, smoking, diuretic use, state anxiety and age as significant variables. Only 59 patients agreed to treatment with a phosphodiesterase-5 inhibitor, with positive results in 45 (76.27%). Treatment was contraindicated in 41 patients because they were taking nitrates for myocardial ischemia. The remaining patients expressed no interest, had relationship problems or were worried about complications.
  
  
  CONCLUSIONS
  The incidence of erectile dysfunction was substantial. The condition was directly associated with risk factors for atherosclerosis, treatment, and psychological disorders (i.e., anxiety and depression). Relationship problems and the fear of complications may explain why many patients refused to take phosphodiesterase-5 inhibitors.
authors.affiliation: Unidad de Rehabilitación Cardiaca, Servicio de Cardiología, Hospital Ramón y Cajal, Madrid, Spain. jmmmcp@yahoo.es
authors.forename: José M
authors.initials: JM
authors.lastname: Maroto-Montero
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Portuondo-Maseda
authors.forename: Maximino
authors.initials: M
authors.lastname: Lozano-Suárez
authors.forename: Antonio
authors.initials: A
authors.lastname: Allona
authors.forename: Carmen
authors.initials: C
authors.lastname: de Pablo-Zarzosa
authors.forename: María D
authors.initials: MD
authors.lastname: Morales-Durán
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel-Garcia
authors.forename: Ana
authors.initials: A
authors.lastname: Royuela-Vicente
mesh_terms: D007172:Erectile Dysfunction / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000534:rehabilitation*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000209:etiology