221 Comparing Erectile Dysfunction with Traditional Vascular Risk Factors in the Prediction of Coronary Artery Disease in Patients Presenting with Chest Pain. (6th June 2015) - Androshchuk, Vitaliy
Abstract : Introduction: Erectile dysfunction (ED) is the persistent inability to attain or maintain an erection and affects up to 52% of men between the ages of 40 and 70. ED is an independent predictor of clinically overt cardiovascular (CV) events, coronary artery disease (CAD), stroke and all-cause mortality, preceding these by 2–5 years. ED has not been evaluated in patients referred to a rapid access chest pain clinic (RACPC) for suspected CAD. Purpose: To prospectively investigate ED in patients referred to the RACPC and to assess ED as an independent predictor of CAD in these patients. Methods: All male patients attending RACPC between October 2012 and February 2014 were eligible. ED was measured using a well validated 5-item International Index of Erectile function (IIEF-5) questionnaire, with ED being defined as IIEF-5 of ≤21 out of 25. ED was further categorised into mild-moderate (IIEF-5: 11–21) and severe (IIEF-5: ≤10). All patients underwent an exercise tolerance test (ETT) according to Bruce protocol where appropriate as a first line investigation. When this was not possible, patients underwent a functional imaging (stress echocardiography [SE] or myocardial perfusion scintigraphy [MPS]). Patients with positive or inconclusive studies went on to have coronary angiography (CA). Patients were considered to have CAD if they had a positive ETT, SE, MPS or CA. Results were analysed using Chi-squared test for categorical data and one-way ANOVA for continuous data. Stepwise Binary logistic regression model was used to determine the contribution of traditional risk factors and the presence of ED to the prediction of CAD. P-value less than 0.05 was considered significant. Results: Our study cohort constituted 181 patients. Of these, 26 (14%) could not complete IIEF-5. Of the remaining 155 participants, 53 (34%) had normal erectile function (IIEF-5: ≥22). Of 102 (66%) ED patients, 55 (36%) had mild-moderate ED and 47 (30%) had severe ED. Patients with ED reported more risk factors than patients without ED, including smoking (68% vs. 55%, p = 0.004), diabetes (9% vs. 23%, p = 0.029), and hypertension (30% vs. 56%, p = 0.002). More patients with ED had CAD (47% vs. 25%, p = 0.014). Using stepwise Binary logistic regression including hypertension, hypercholesterolemia, smoking, diabetes, family history and ED as covariates, hypercholesterolemia (p = 0.045) and ED (p = 0.007) were significant independent predictors of CAD (r2=0.135, p = 0.001). Conclusions: ED may be a more powerful predictor of CAD in male patients with chest pain when compared to traditional vascular risk factors.