ED May Predict Heart Disease in Diabetic Men

Study Shows Erectile Dysfunction Bigger Predictor Than Blood Pressure, Cholesterol Levels

From the WebMD Archives

June 21, 2004 -- Erection problems may soon join high cholesterol, hypertension, and other well-documented risks as a way to predict likely heart disease in a group of people especially vulnerable to it -- men with type 2 diabetes.

In a new study, Italian researchers say that erectile dysfunction proved to be a stronger prediction of "silent" heart disease than more traditional heart disease risk factors such as high LDL (or "bad") cholesterol, low HDL (or "good") cholesterol, high blood pressure, or smoking.

The study looked at 260 diabetic men -- most were in their late 50s and had type 2 diabetes for about seven years with no known complications.

The researchers showed that men with type 2 diabetes and "silent" heart disease were nine times more likely to have erectile dysfunction.

"If our findings are confirmed, erectile dysfunction may become a potential marker to identify diabetic patients to screen for silent cardiovascular disease," says study researcher Carmine Gazzaruso, MD, of Maugeri Foundation Hospital in Pavia, Italy.

But cardiologist Ira S. Nash, MD, a spokesman for the American Heart Association, tells WebMD that this finding probably won't mean very much in treating diabetic patients.

"I don't think this is so earth-shattering," says Nash, of Mount Sinai School of Medicine in New York City. " I have no reason to doubt that's accurate. But the question really is, if you know everything else about a patient, what's the marginal value in also knowing whether a patient has erectile dysfunction or not?"

A Three-Way Connection

Previous studies have shown that erectile dysfunction (ED) occurs in men with either diabetes or heart disease -- diseases in which blood vessels are damaged. Erectile dysfunction afflicts men with diabetes three times more often, and typically a decade earlier, than men without diabetes.

According to Alan J. Garber, MD, PhD, a hormone specialist of Baylor College of Medicine, one of every two men with type 2 diabetes will eventually develop erectile dysfunction. Of course, diabetes also increases risk of heart disease, often by damaging blood vessels and impeding blood flow, which are necessary for erections.


But even in men without diabetes, problems with erections could be an early warning sign of impeding heart disease, especially when impotence occurs at a younger age.

Earlier this year, researchers from St. Paul Heart Clinic in Minnesota reported in the Journal of the American College of Cardiology that erectile dysfunction might be an early warning sign of damaged blood vessels that can result in an increased risk of heart attacks or strokes. They showed that men in their 40s who had erectile dysfunction but otherwise appeared to be healthy had subtle problems seen on testing their arteries. This indicated that although these men appeared healthy, they had heart disease.

Still, Gazzaruso says his study is the first to look at how both diabetes and ED could predict the risk of "silent" heart disease that often strikes men with diabetes.

No Warnings, Serious Results

"In diabetic patients, cardiovascular disease may be silent and is asymptomatic more frequently than in non-diabetic patients," Gazzaruso tells WebMD. "It's a strong predictor of coronary events and early death, especially in diabetic patients."

In his study, to be published in the July 6 issue of Circulation, Gazzaruso's teamevaluated the presence of erectile dysfunction and other heart disease risk factors in 133 diabetic men with heart disease and 127 diabetic men without heart disease.

While the men with heart disease were twice as likely to smoke and have a slightly higher family history, no heart disease risk factor was as widely different between the two groups of men as erectile dysfunction.

A third of diabetic men with heart disease suffered from erectile dysfunction, compared with fewer than 5% of men with type 2 diabetes and no coronary heart disease.

What does this mean to you?

"Patients should not deny the presence of erectile dysfunction and inform their physician if they problems. On the contrary, the patient should spontaneously inform his physician on his ED," Gazzaruso tells WebMD. "It also means that physicians always should investigate the presence of ED in diabetic patients."

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SOURCES: Gazzaruso, C. Circulation, July 6, 2004. Kaiser, D. Journal of the American College of Cardiology, Jan. 21, 2004; vol 43: pp 179-184. Carmine Gazzaruso, MD, internist/diabetologist, IRCCS Maugeri Foundation Hospital, Scientific Institute of Pavia, Italy. Ira S. Nash, MD, cardiologist and associate professor of medicine, Mount Sinai School of Medicine, New York; spokesman, American Heart Association. Alan J. Garber, MD, PhD, professor of medicine, biochemistry and molecular biology, and molecular and cellular biology, Baylor College of Medicine, Houston.
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