The aim of this prospective study was to determine the prevalence and risk factors for erectile dysfunction (ED) in cardiac rehabilitation (CR). Three hundred fifty-two coronary and noncoronary men (mean age = 55, range = 25-82 years) were screened by the psychologist for ED upon admission. ED was measured via the IIEF-5 questionnaire. Admissions were due to coronary artery bypass grafting (37%), coronary angioplasty/stent (32%), angor pectoris or myocardial infarction (7%), aortic/mitral valve replacement (11%), and other (13%).
The prevalence of ED was 78%. Severity distribution was as follows: 35% had mild ED (IIEF5: 17-21), 22% mild to moderate (IIEF5: 12-16), 10% moderate (IIEF5: 8-11) and 11% severe ED (IIEF5: 5-7). Moreover, in 80% of cases, patients recall ED up to 28 +/- 33 month prior to cardiovascular event.
There was a significant positive correlation between age and severity of ED (P < .001). Patients' age group was defined as such <=39 years, 40 to 49, 50 to 59, and <=60 years. The median IIEF-5 obtained for the above-defined age group was respectively 22, 20, 18, and 16.
ED was significantly higher in patients with coronary heart disease, type2 diabetes, and hypertension (all P < .001). A low peak of Vo2 < 14 mL kg-1 min-1 (P < .001), LVEF <=35% (P < .05) and ankle-brachial index < 0.9 (P < .01) were significantly associated with mild to severe ED. Levels of cholesterol, smoking, body mass index, and waist circumference was not associated with ED.
On the other hand, the risk of ED was significantly higher for patients using diuretic (P<.05), and higher, but statistically insignificant, for patients using calcium channel inhibitor (P=.06), angiotensinII antagonist (P = .05), as compared to nonusers. Use of [beta]-blockers, angiotensin-converting enzyme inhibitors, and statins showed no correlation with ED.
Finally, ED was significantly correlated with anxiety (P = .025), depression (P < .001) (HAD scale), marital status (P < .05), professional inactivity (P = .005) and lower level of education (P < .05).
Conclusion: ED is frequent in CR patients and should be screened, more particularly in patients with high-risk cardiovascular. Diuretics increase ED. Finally, ED is correlated with depression/anxiety and psychosocial factors. Further investigations of the impact of a CR program on ED would be of utmost interest.