The association between erectile dysfunction and peripheral arterial disease as determined by screening ankle-brachial index testing

Abstract

Background Peripheral arterial disease (PAD) is a potent marker of adverse cardiovascular prognosis, yet PAD frequently remains asymptomatic or undiagnosed. Erectile dysfunction (ED) has been associated with atherosclerosis, but whether ED is an independent predictor of PAD is unknown. We hypothesized that ED is a marker for previously undiagnosed PAD, and thus ED may identify men who would benefit from screening ankle-brachial index (ABI). Methods 690 male patients (pts) who had been referred for stress testing, and were without known PAD were prospectively screened for ED and PAD, using the International Index of Erectile Function (IIEF) questionnaire, and ABI, respectively. ED was defined by a score of ≤25 on the ED domain of the IIEF, PAD was defined as an ABI ≤ 0.9. Results ED was present in 45% of pts and PAD was present in 23%. Of pts found to have PAD, 66% reported no lower extremity symptoms. Men with ED were found to have significantly more PAD than men without ED (32% vs. 16%, p < 0.01), and there was a stepwise increase in the prevalence of PAD with increasing ED severity (28% of men with mild ED, 33% with moderate ED, 40% with severe ED, p < 0.001). On multivariate logistic regression analysis ED (OR 1.97, 95% CI 1.32–2.94, p = 0.002), was an independent predictor of PAD. Conclusions In men referred for stress testing, erectile dysfunction is an independent predictor of PAD as determined by screening ABI examination, and increasing severity of ED is associated with increasing prevalence of PAD. These results suggest that men with ED might be targeted for screening ABI evaluation.