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ORIGINAL RESEARCH—ERECTILE DYSFUNCTION: Erectile Dysfunction Severity as a Risk Predictor for Coronary Artery Disease


Sepehr Salem, MD, Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Sq., Tehran, 1136746911, Iran. Tel: +98-21-66717447; Fax: +98-21-66717447; E-mail:;


Introduction.  Erectile dysfunction (ED) is now beginning to be considered as an early manifestation of a subclinical systemic vascular disorder and may be an index of subclinical coronary artery disease (CAD).

Aim.  To further evaluate whether ED is a predicting factor for CAD while adjusting for other common risk factors.

Methods.  One hundred eighty-three patients with newly diagnosed and documented CAD and 134 participants without CAD were enrolled in this case-control study at our referral center. Univariate and multivariate logistic regression analysis were performed to assess the effect of classic risk factors and ED severity on CAD; calculating odds ratio (OR) and 95% confidence interval (CI). Adjustments were made for potential confounding factors including age, hypertension, diabetes, dyslipidemia, obesity, and smoking.

Main Outcome Measures.  The prevalence of ED and the distribution of CAD risk factors (age, smoking, lipid profile, hypertension, obesity, and diabetes mellitus) were evaluated. The 5-item International Index of Erectile Function was used to evaluate the presence and the severity of ED.

Results.  The prevalence of ED in CAD-positive and CAD-negative groups was 88.5% and 64.2%, respectively (P < 0.05). A statistically significant difference was found for all risk factors (except total cholesterol and low-density lipoprotein levels), and also ED prevalence between studied groups. Adjusted OR for age, diabetes, hypertension, hypercholesterolemia, and smoking demonstrated a significant confounding effect. Our results also revealed a significant association between severe ED and CAD (OR: 2.22, 95% CI: 1.11–6.03; P < 0.05).

Conclusion.  This study suggests that ED could be considered as a surrogate marker which can predict the occurrence of CAD, and severe ED could be regarded as an independent risk predictor in addition to the established ones. Salem S, Abdi S, Mehrsai A, Saboury B, Saraji A, Shokohideh V, and Pourmand G. Erectile dysfunction severity as a risk predictor for coronary artery disease. J Sex Med 2009;6:3425–3432.