Microvascular endothelial dysfunction predicts the development of erectile dysfunction in men with coronary atherosclerosis without critical stenoses

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary atherosclerosis without critical stenoses (n=130). Intervention: Coronary microvascular endothelial dysfunction (% change in coronary blood flow to intracoronary acetylcholine 50%). Primary outcome: Incident erectile dysfunction assessed by patient questionnaire (OR 2.67, 95% CI 1.13-6.6, p=0.024).

Martin Reriani; Andreas J. Flammer; Jing Li; Megha Prasad; Charanjit S. Rihal; Abhiram Prasad; Ryan J. Lennon; Lilach O. Lerman; Amir Lerman

doi:10.1097/mca.0000000000000145

July 15, 2014Coronary Artery DiseaseOpen Access

Microvascular endothelial dysfunction predicts the development of erectile dysfunction in men with coronary atherosclerosis without critical stenoses

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Key result

Coronary microvascular endothelial dysfunction linked to ~2.7-fold higher odds of incident erectile dysfunction.

OR 2.67
95% CI 1.13-6.6
P=0.024
n=130

Why the study?

Does baseline coronary microvascular endothelial dysfunction predict the development of erectile dysfunction in men with coronary atherosclerosis without critical stenoses?

Key Points

To determine whether coronary microvascular endothelial dysfunction predicts the development of erectile dysfunction in men with coronary atherosclerosis without critical stenoses.
Evaluated coronary microvascular endothelial function in 130 men with coronary atherosclerosis without critical stenoses by intracoronary administration of acetylcholine during diagnostic catheterization.
Assessed patients for the subsequent development of erectile dysfunction via questionnaire after a mean follow-up of 8.4 years (mean duration 8.4 ± 4.7 years).
At baseline, 68 men (50%) had microvascular endothelial dysfunction; 35 (51%) of these men developed erectile dysfunction during follow-up compared with 19 (31%) men without dysfunction (P=0.016).
Coronary blood flow response (% ΔCBF) was lower in men who developed erectile dysfunction compared with those who did not (mean ± SD of 25.4 ± 71.3 vs. 81.7 ± 120, P=0.003).
Microvascular endothelial dysfunction predicted erectile dysfunction development in univariate analysis (relative risk 2.4, 95% CI 1.2–4.9, P=0.016) and remained an independent predictor in multivariate logistic regression (P=0.027) alongside age (P=0.044).

Study Design

Type

Cohort (n=130)

Multicenter

No

Structured PICO

Does baseline coronary microvascular endothelial dysfunction predict the development of erectile dysfunction in men with coronary atherosclerosis without critical stenoses?

P

Population

130 men (mean age 50 years) with non-obstructive coronary atherosclerosis (stenosis <=40%, LVEF >=45%) and free from baseline erectile dysfunction, followed for a mean of 8.4 years.

E

Exposure

Coronary microvascular endothelial dysfunction defined as <=50% increase in coronary blood flow (% ΔCBF) in response to intracoronary acetylcholine infusion (10^-6, 10^-5, and 10^-4 mol/L at 1 mL/min for 3 minutes) into the left anterior descending coronary artery (n=68)

C

Comparator

Normal coronary microvascular endothelial function defined as >50% increase in coronary blood flow (% ΔCBF) in response to intracoronary acetylcholine infusion (n=62)

O

Outcome

Incident erectile dysfunction (new diagnosis after baseline coronary vascular reactivity study) assessed by patient self-report questionnaire at mean follow-up of 8.4 ± 4.7 yearspatient reported

Main Result

Odds Ratio: 2.67 (95% CI 1.13–6.6)

Absolute Event Rate: 51% vs 31%

p-value: p=0.024

Coronary microvascular endothelial dysfunction is an independent predictor of future erectile dysfunction in middle-aged men with non-obstructive coronary atherosclerosis, underscoring the systemic nature of microvascular endothelial dysfunction.

Limitations

Erectile dysfunction was determined by unvalidated patient self-report questionnaires, introducing potential recall bias and underestimation.
Did not differentiate between vasculogenic erectile dysfunction and erectile dysfunction from other causes (no penile Doppler ultrasound performed).
Study was not designed to measure whether treatment-induced improvement in endothelial function impacted the diagnosis of erectile dysfunction.
Development of erectile dysfunction was determined by self-reported, unvalidated questionnaires, introducing risk of underestimation and recall bias.
Not designed to measure if treatment-related improvement in endothelial function impacted the diagnosis of erectile dysfunction.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Should not yet change risk assessment; extends systemic microvascular dysfunction links but remains hypothesis-generating.

Abstract

BACKGROUND: Erectile dysfunction (ED) is associated with an increased risk for cardiovascular disease, stroke, and all-cause mortality, independent of conventional cardiovascular risk factors. Coronary endothelial dysfunction is independently associated with ED in men with early coronary atherosclerosis. We aimed to investigate whether coronary microvascular dysfunction predicts development of ED in patients presenting with coronary atherosclerosis without critical stenoses. PATIENTS AND METHODS: Coronary microvascular function was evaluated in 130 men with coronary atherosclerosis without critical stenoses by administration of intracoronary acetylcholine at the time of diagnostic study. After a mean follow-up of 8.4 years, patients were assessed for the development of ED by administration of a questionnaire. RESULTS: In all, 68 (50%) men had microvascular endothelial dysfunction at baseline; 35 (51%) men with microvascular endothelial dysfunction developed ED on follow-up compared with 19 (31%) men without microvascular endothelial dysfunction. Men who developed ED had a lower coronary blood flow response (% [INCREMENT]CBF) compared with men who did not develop ED, with mean±SD of 25.4±71.3 versus 81.7±120 (P=0.003). In univariate analysis, microvascular endothelial dysfunction was a predictor for the development of ED, with relative risk of 2.4 (1.2-4.9) (P=0.016). In multivariate logistic regression adjusting for traditional cardiovascular risk factors (age, hypertension, hyperlipidemia, diabetes, vascular disease, and family history of coronary artery disease), only microvascular endothelial dysfunction (P=0.027) and age (P=0.044) remained significant predictors of development of ED. CONCLUSION: Coronary microvascular dysfunction is a predictor of the development of ED in men with coronary atherosclerosis without critical stenoses. This study underscores the systemic involvement of the endothelial function in vascular disease.

Discussion

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Cite This Study

Reriani et al. (2014) conducted a cohort in Coronary atherosclerosis without critical stenoses (n=130). Coronary microvascular endothelial dysfunction (% change in coronary blood flow to intracoronary acetylcholine <=50%) vs. Normal coronary microvascular endothelial function (% change in coronary blood flow to intracoronary acetylcholine >50%) was evaluated on Incident erectile dysfunction assessed by patient questionnaire (OR 2.67, 95% CI 1.13-6.6, p=0.024). Coronary microvascular endothelial dysfunction independently predicted incident erectile dysfunction over 8.4 years of follow-up.

synapsesocial.com/papers/6a7af8a2756812e39589d614 https://doi.org/10.1097/mca.0000000000000145

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Microvascular endothelial dysfunction predicts the development of erectile dysfunction in men with coronary atherosclerosis without critical stenoses

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Microvascular endothelial dysfunction predicts the development of erectile dysfunction in men with coronary atherosclerosis without critical stenoses

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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