Internal Medicine, Diabetes, Endocrine-Metabolic Diseases and Cardiovascular Prevention Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute Beato Matteo, Corso Pavia 84, Vigevano, 27029, Pavia, Italy.
Endocrine. 2011 Oct;40(2):273-9. doi: 10.1007/s12020-011-9523-9. Epub 2011 Aug 23.
About 40% of diabetic patients with asymptomatic coronary artery disease (CAD) are missed on the basis of the current screening guidelines. Erectile Dysfunction (ED) is a powerful marker of asymptomatic CAD. Aim of the study is to evaluate whether ED can improve the effectiveness of the current guidelines for the screening of CAD in diabetes. From among 299 consecutive men with newly diagnosed type 2 diabetes without any apparent vascular complication, 293 (mean age 56.6±5.9 years) were enrolled. Among them, 219 did not have myocardial ischemia (NO CAD group) and 74 men had a coronary stenosis angiographically proven (CAD group). Five risk factors (RFs) of the current screening guidelines (hypertension, dyslipidemia, family history for CAD, smoking e micro/macroalbuminuria) and ED were assessed. ED was significantly more prevalent in the CAD than in the NO CAD group (37.8 versus 15.1%; P<0.001) and was a predictor of asymptomatic CAD (OR: 4.4; 95%CI: 2.1-9.0; P<0.001). If ED is added to the list of RFs, it can increase the sensitivity of the current guidelines from 62 to 89%, without a significant variation in specificity (from 60 to 57%). The negative predictive value can increase from 82 to 94%. ED can reduce from 37.84 to 10.81% the percentage of patients with silent CAD missed at the screening. This study first shows that ED can improve the effectiveness in discriminating diabetic men to screen for asymptomatic CAD, when it is added to the list of RFs of the current screening guidelines.
约 40%患有无症状冠状动脉疾病（CAD）的糖尿病患者会根据现行的筛查指南被漏诊。勃起功能障碍（ED）是无症状 CAD 的有力标志物。本研究旨在评估 ED 是否可以提高现行 CAD 筛查指南对糖尿病患者的筛查效果。在 299 例新诊断为 2 型糖尿病且无任何明显血管并发症的连续男性中，纳入 293 例（平均年龄 56.6±5.9 岁）。其中 219 例没有心肌缺血（无 CAD 组），74 例男性经冠状动脉造影证实有冠状动脉狭窄（CAD 组）。评估了现行筛查指南的 5 个危险因素（RFs）（高血压、血脂异常、CAD 家族史、吸烟和微量/大量白蛋白尿）和 ED。CAD 组 ED 的患病率明显高于无 CAD 组（37.8%比 15.1%；P<0.001），且是无症状 CAD 的预测因素（OR：4.4；95%CI：2.1-9.0；P<0.001）。如果将 ED 添加到 RFs 列表中，可以将现行指南的敏感性从 62%提高到 89%，特异性（从 60%到 57%）没有显著变化。阴性预测值可以从 82%提高到 94%。ED 可以将无症状 CAD 漏诊的患者比例从 37.84%降低到 10.81%。本研究首次表明，当 ED 被添加到现行筛查指南的 RFs 列表中时，ED 可以提高鉴别糖尿病男性筛查无症状 CAD 的效果。
