ED in Men With Diabetes Is a Powerful Predictor of Heart Disease

By Paula Rasich

(CardioSmart) If you’re a man over 40 with diabetes and you suffer from erectile dysfunction (ED), heart experts say that’s reason enough to suspect heart disease.

According to two new studies published in the May 26th issue of the Journal of the American College of Cardiology, ED can be like the “check engine” light on your car’s dashboard — a sign it’s time for a tune-up.

“Coronary artery disease is very common in the diabetic population, and a lot of people with diabetes have coronary disease and aren’t aware of it,” says cardiologist Robert A. Kloner, MD, PhD, director of research at the Heart Institute of Good Samaritan Hospital in Los Angeles. ED is also common in diabetics, particularly in older patients, and those with a longer duration of diabetes.

Although ED was once considered primarily a psychological problem, in the majority of men over the ages of 40, ED is most likely due to vascular disease. “If blood vessels are abnormal in one vascular bed of the body, then there’s a good chance they’re abnormal in other vascular beds of the body,” Dr. Kloner says. So, ED in diabetics may be an especially powerful warning sign of heart disease, and a harbinger of subsequent cardiac events.

To investigate this connection, a group of Chinese scientists, led by Ronald Chin-Wan Ma, MA, followed more than 2,300 diabetic men without known heart disease for four years. The researchers found that diabetic men with ED had a 1.6-fold increased risk of developing coronary heart disease compared to those without ED. “Men with diabetes need to be aware that ED may be a warning sign of atherosclerotic coronary disease,” says Dr. Kloner. “Symptoms of ED might show up first because penile arteries are smaller in diameter than coronary arteries.”

In a second study, Italian researchers followed 291 men with type 2 diabetes who had coronary artery disease (CAD) diagnosed during coronary angiography. After following these individuals for an average of 4 years, Carmine Gazzaruso MD, PhD and colleagues found that men with ED had twice the rate of heart attack, stroke, unstable angina, and other major heart events compared to men who did not have ED.

Dr. Gazzaruso also found that treatment with statin medications significantly improved the outlook for men with ED, suggesting that aggressive treatment of risk factors is important in this patient subgroup. Additionally, treatment with PDE5 inhibitors (examples include Viagra®, Levitra®, and Cialis ®) was associated with a lower risk of subsequent cardiac events.

Both studies conclude that patients with diabetes and ED represent a particularly high risk group and may benefit from early identification and more aggressive risk factor management. “The good news is that there’s a lot that we can do with preventative cardiology by identifying and treating the risk factors,” says Dr. Kloner. In an accompanying editorial, Kloner also writes that “the time has come to study PDE5 inhibitors systematically as potential therapies for the prevention of adverse cardiac events in patients with vascular risk factors.”

Sources:

Robert A. Kloner, MD, PhD, Director of Research at the Heart Institute of Good Samaritan Hospital, Los Angeles; Professor of Medicine, Keck School of Medicine at the University Southern California, Cardiovascular Division, Los Angeles.

Gazzaruso et al.  Erectile Dysfunction as a Predictor of Cardiovascular Events and Death in Diabetic Patients with Asymptomatic Coronary Artery Disease Angiographically Proven. Journal of the American College of Cardiology 2008.

Ma et al.  Erectile Dysfunction Predicts Coronary Heart Disease in Type 2 Diabetes. Journal of the American College of Cardiology 2008.

Kloner. The New Harbinger for Major Adverse Cardiac Events in the Diabetic Patient. Journal of the American College of Cardiology 2008.