title: Erectile dysfunction can improve the effectiveness of the current guidelines for the screening for asymptomatic coronary artery disease in diabetes.
abstract: About 40% of diabetic patients with asymptomatic coronary artery disease (CAD) are missed on the basis of the current screening guidelines. Erectile Dysfunction (ED) is a powerful marker of asymptomatic CAD. Aim of the study is to evaluate whether ED can improve the effectiveness of the current guidelines for the screening of CAD in diabetes. From among 299 consecutive men with newly diagnosed type 2 diabetes without any apparent vascular complication, 293 (mean age 56.6±5.9 years) were enrolled. Among them, 219 did not have myocardial ischemia (NO CAD group) and 74 men had a coronary stenosis angiographically proven (CAD group). Five risk factors (RFs) of the current screening guidelines (hypertension, dyslipidemia, family history for CAD, smoking e micro/macroalbuminuria) and ED were assessed. ED was significantly more prevalent in the CAD than in the NO CAD group (37.8 versus 15.1%; P<0.001) and was a predictor of asymptomatic CAD (OR: 4.4; 95%CI: 2.1-9.0; P<0.001). If ED is added to the list of RFs, it can increase the sensitivity of the current guidelines from 62 to 89%, without a significant variation in specificity (from 60 to 57%). The negative predictive value can increase from 82 to 94%. ED can reduce from 37.84 to 10.81% the percentage of patients with silent CAD missed at the screening. This study first shows that ED can improve the effectiveness in discriminating diabetic men to screen for asymptomatic CAD, when it is added to the list of RFs of the current screening guidelines.
authors.affiliation: Internal Medicine, Diabetes, Endocrine-Metabolic Diseases and Cardiovascular Prevention Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute Beato Matteo, Corso Pavia 84, Vigevano, 27029, Pavia, Italy. c.gazzaruso@gmail.com
authors.forename: Carmine
authors.initials: C
authors.lastname: Gazzaruso
authors.forename: Adriana
authors.initials: A
authors.lastname: Coppola
authors.forename: Tiziana
authors.initials: T
authors.lastname: Montalcini
authors.forename: Cinzia
authors.initials: C
authors.lastname: Valenti
authors.forename: Adriana
authors.initials: A
authors.lastname: Garzaniti
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pelissero
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Salvucci
authors.forename: Pietro
authors.initials: P
authors.lastname: Gallotti
authors.forename: Arturo
authors.initials: A
authors.lastname: Pujia
authors.forename: Colomba
authors.initials: C
authors.lastname: Falcone
authors.forename: Sebastiano B
authors.initials: SB
authors.lastname: Solerte
authors.forename: Andrea
authors.initials: A
authors.lastname: Giustina
mesh_terms: D015415:Biomarkers; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D042241:Early Diagnosis; D007172:Erectile Dysfunction / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers