Relation Between Severity of Coronary Artery Disease and Aorto-Ilio-Pudendal Artery Disease in Patients with Ischemic Heart Disease–Associated Vascular Erectile Dysfunction

Abstract

Background The angiographically documented association between severity of coronary artery disease (CAD) and aorto-ilio-pudendal (A-I-P) artery disease and vascular erectile dysfunction (ED) was not yet settled. Aim To assess the relation between angiographically proved CAD and A-I-P artery disease in patients with ischemic heart disease (IHD)–associated vascular ED. Methods 60 men were assigned to 3 study groups: Group 1 (n = 25), patients who had IHD and ED; group 2 (n = 25), patients who had IHD and had no ED; group 3 (n = 10), patients who had ED and had no suspected IHD. All patients were subjected to detailed medical, cardiac, and sexual history. International Index of Erectile Function and penile color Doppler ultrasound were used to assess ED. Quantitative coronary angiography and invasive angiography were used to assess the vascular tree for the right and left (A-I-P) arteries. Endothelial markers, that is, endothelial microparticles and endothelial progenitor cells were also assessed. Outcomes The main outcome measures are assessment of ED and angiographically proved CAD and A-I-P artery disease. Results The mean age ± SD of the 3 study groups were 50.4 ± 6.6, 51.4 ± 3.9, and 49.9 ± 6.1 years, respectively, with no statistically significant difference among groups (P = .380). There were significant higher rates of left main (LM) lesions (≥50%), CAD (≥70%), right and left internal pudendal artery lesions, and right and left internal iliac artery lesions in G1 in comparison with G2 and G3. Patients with ED alone had a higher rate of peripheral lesions compared with patients with CAD alone. 10 percent of patients with ED alone had CAD. Patients in G1 had notably higher rates of peripheral lesions than the other groups combined Patients with left internal pudendal artery lesions had a chance by 1.25 and 2.11 times to have LM lesions and significant CAD, respectively. There was a significant increase of endothelial microparticles in G1 in comparison with other groups (P < .05). Clinical Implications The clinical implications are uses of peripheral angiograghy as a diagnostic tool in patients with CAD-associated vascular ED may have a clinical merit. Strengths & Limitations The strengths in the present study are the use of angiography, color Doppler ultrasound, and standardized instruments. The main limitations are the small sample size and lack of intervention and longitudinal data. Conclusion ED correlates more with A-I-P vascular lesions compared with CAD alone. There was a statistically significant association between severity of CAD including LM significant lesions and A-I-P arteries disease in patients with CAD-associated vascular ED.

Erectile dysfunction and angiographic correlation between coronary artery stenosis and internal iliac-internal pudendal artery stenosis in patients with suspected coronary artery disease: a retrospective study

“…Our results showed that the degree of coronary artery stenosis correlates with the degree of II-IPA stenosis, which agrees with the findings of Rogers et al [18] and Sanad et al [19]. We believe that these findings confirm the reasonable assumption that there is a correlation between coronary artery stenosis and II-IPA stenosis because CAD and ED are linked to the common pathophysiology of vascular endothelial dysfunction.…”

“…Rogers et al [18] performed CAG and PA in 10 patients with suspected CAD and ED who were nonresponsive to phosphodiesterase-5 inhibitor (PDE5i) and reported a correlation between CAD and IPA disease in patients with ED. Sanad et al [19] performed CAG and PA to examine the relationship between angiographically verified CAD and aorto-ilio-pudendal (A-I-P) artery disease in patients with ischemic heart disease-associated vascular ED (n = 60). They reported that ED correlates with A-I-P vascular lesions than with CAD alone, and that there was a significant association between the severity of CAD and A-I-P artery disease in patients with CAD associated with ED.…”

“…ED can manifest even in the early stages of endothelial dysfunction prior to plaque formation. Sanad et al [19] reported that angiographically confirmed CAD was present in 10% of patients complaining of ED but without clinical symptoms of CAD. Our study results support the opinion that ED precedes CAD by 5 years.…”

Phenotypic Disease Network Analysis to Identify Comorbidity Patterns in Hospitalized Patients with Ischemic Heart Disease Using Large-Scale Administrative Data

“…Despite the growing amount of evidence that IHD has high co-existing morbidity burden, previous studies investigating IHD comorbidity have been predominately focused on a few common diseases and interpreted them using prevalence statistics and correlation analysis [ 7 , 9 , 10 , 12 , 13 ], without a comprehensive investigation of associations between comorbidities in patients with IHD, and most of these studies were conducted in Western countries [ 15 , 16 , 17 , 18 ]. There is still a significant gap in knowledge regarding the comorbidity patterns of IHD, especially among Chinese individuals, who tend to exhibit different lifestyles and eating habits from those observed in Western countries.…”