Erectile Dysfunction: A Significant Health Need in Patients with Coronary Heart Disease.

Stuart Hood, Consultant Cardiologist               

Irene Robertson , Cardiac Rehabilitation Sister 

Cardiology Department, Royal Alexandra Hospital, Paisley, PA2 9PN

SMJ 2004 49(3): 90-92

 

Abstract

Background and Aims

Erectile dysfunction (ED) is a common condition, which negatively affects quality of life, and shares similar risk factors with Coronary Heart Disease (CHD). Studies from the pre – sildenafil era confirm a higher risk of ED in patients with cardiovascular disease. The high profile and success of sildenafil therapy has made it easier for some men to discuss erectile difficulties with healthcare professionals. Our aim therefore was to estimate the prevalence of ED in our cardiac rehabilitation patients

Methods and Results

We surveyed 150 random male cardiac rehabilitation patients using the International Index of Erectile Function (IIEF) questionnaire. 61% of all respondents had erectile difficulties, rising to 75% in the over 55 age group. 48% of respondents indicated their wish to discuss erectile problems with the healthcare team.

Conclusion.

ED and CHD commonly co-exist.  A large proportion of our respondents wished further discussion of erectile insufficiency. We recommend that cardiac rehabilitation programmes should adopt a proactive approach to detection and treatment of ED

 

Key words: Erectile dysfunction; Cardiac rehabilitation; Coronary Heart Disease

Background and aims

Erectile dysfunction (ED) is a common condition. Historical data suggests10% of men in the general population and 44% of patients with previous myocardial infarction (MI) may suffer from ED.1,2  This data however pre dates the availability of successful oral therapy for ED. The development of sildenafil raised public awareness of ED encouraging some men to voice their problems. It is possible therefore that these older studies have underestimated the prevalence of ED and that a significant unmet health need persists in patients with coronary artery disease. ED negatively influences quality of life in both patient and partner3 and in one study was implicated in 20% of relationship breakdowns.4 Despite this, patients and doctors remain generally reluctant to discuss sexual dysfunction even though treatment of ED can improve quality of life in both patient and partner.5 Anecdotally, very few patients in our cardiac rehabilitation clinic volunteer symptoms of ED suggesting many patients may be suffering in silence. Given that CHD and ED share common risk factors, cardiac rehabilitation programmes are ideally placed to enquire about symptoms of ED and to initiate treatment. We undertook this survey to estimate the prevalence of ED in our male CHD subjects.

 

Methods and Results

The International Index of Erectile Function (IIEF) questionnaire (see table I) was issued to 150 random male participants in our cardiac rehabilitation programme. Entry into the programme is offered to patients attending our hospital with a confirmed diagnosis of CHD and is not restricted to those who have suffered a previous MI or undergone a revascularisation procedure. The IIEF questionnaire consists of five questions concerning erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction.6 For each question there are several possible answers and subjects circle the response which best describes their situation. The options are assigned a score of 0-5 (maximum score 25). A total score of 21 or less indicates potential erectile dysfunction.

 

Seventy-five of 150 (50%) questionnaires were returned, of which 70 (47%) were fully completed. 43 patients (61%) had IIEF scores of 21 or less indicating possible erectile dysfunction. IIEF scores <21 were more common in older patients, occurring in 11 (39%) of patients younger than 55 and in 32 (76%) patients older than 55. Thirty-six (48%) of respondents wished further discussion of erectile difficulties. Of those who wished to discuss erectile issues, 27 patients (75%) had IIEF scores <21. Of patients who expressed a preference, 16 (31%) felt most comfortable discussing erectile problems with their hospital cardiologist, 19 (37%) with their GP and 8 (16%) with cardiac rehabilitation nurses.

 

Conclusion

We identified a higher than previously reported prevalence of erectile dysfunction in male patients with coronary heart disease. This is not unexpected as ED and cardiovascular disease have similar risk factors. Recent evidence suggests that endothelial dysfunction is the common denominator in both conditions.7 Of course there are limitations of our small survey, not least a 50% response rate. Nonetheless, the majority of respondents had erectile problems and a large number of them indicated a wish to discuss these issues implying a significant, unmet health need. Cardiac rehabilitation programmes are ideally placed to identify and treat ED. At present however, few patients in our cardiac rehabilitation programme seek treatment for ED. Until recently, therapeutic options for ED were limited and unacceptable to many individuals. Newer, oral phosphodiesterase treatment is, however, convenient, effective and safe in low risk cardiac patients. Initial concern over the safety of these drugs has largely been unfounded but guidelines for risk stratification and management of ED in cardiovascular patients have been published.8 A proactive approach, aiming to identify and treat ED in cardiovascular patients, is recommended.

 

Conflict of interest: SH has received honoraria for speaking and acting as an advisor for many pharmaceutical companies including Pfizer. Both SH and IR have received assistance with travel costs from Pfizer.

 

References

  1. Feldman HA, Goldstein I, Hatzichristou DG et al. impotence and its medical and psychosocial correlates: results of the Massachusetts Male Ageing Study. J Urol 1994;151:54-61

  2. Wabrek AJ, Burchell RC. Male sexual dysfunction associated with coronary heart disease. Arch Sex Behav 1980;9:69-75.

  3. Dunn KM, Croft PR, Hackett GI. Association of sexual problems with social, psychological and physical problems in men and women: a cross sectional population survey. J Epidemiol Community Health 1998;52:10-14

  4. Impotence Association Survey. Taylor Nelson AGB Healthcare, 1997

  5. Quirk F, Guiliano F, Pena B et al. Effect of sildanefil on quality-of-life parameters in men with broad spectrum erectile dysfunction. J Urol 1998;159(suppl 5):260.

  6. Rosen RC, Riley A, Wagner G et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49(6):822-30.

  7. Solomon H, Man JW and Jackson G. Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart 2003;89:251-253.

  8. DeBusk R, Drory Y, Goldstein I et al. Management of sexual dysfunction in patients with cardiovascular disease: recommendations of the Princeton Consensus Panel. Am J Cardiol 2000;86:175-81.

 

Back to August Contents