A Comparative Study of the Prevalence and Severity of Erectile Dysfunction and Lower Urinary Tract Symptoms in Patients With and Without Significant Coronary Artery Disease Undergoing Coronary Angiography at Kowsar Hospital in Shiraz, Iran

Background: Erectile dysfunction, lower urinary tract symptoms (LUTS), and coronary artery disease (CAD) share common risk factors. Atherosclerosis, inflammation, and endothelial dysfunction with decreased nitric oxide synthase activity are the proposed etiologies for these disorders.

Objective: This study compared the prevalence and severity of erectile dysfunction and LUTS in patients with and without significant CAD.

Methods: This case-control study involved patients undergoing coronary artery angiography at Kowsar Hospital in Shiraz, Iran, between January 2019 and January 2020. Male patients aged 40 or older with or without significant coronary artery lesions diagnosed by coronary angiograms were considered the case and control groups, respectively. Both groups were asked to fill out the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) questionnaires, which evaluate the severity of LUTS and erectile dysfunction, respectively. The prevalence and severity of erectile dysfunction and LUTS were evaluated and compared between the groups using chi-squared tests and t-tests. Also, logistic regression was performed.

Results: A total of 352 male patients participated in this case-control study, and each group included 176 patients. Erectile dysfunction occurred in 109 patients (61.9%) in the case group vs. 63 (35.7%) in the control group (P<  0.001). The mean IIEF-5 score was 17.03 ± 7.33 in the case group vs. 20.56 ± 6.51 in the control group (P = 0.003). Ninety-five patients (54.0%) in the case group complained of LUTS, vs. 51 (29.0%) in the control group (P <  0.001). The mean IPSS score was 7.70 ± 9.28 in the case group and 3.74 ± 3.74 in the control group (P < 0.001).

Conclusion: Erectile dysfunction, LUTS, and CAD share common risk factors and are highly prevalent among the aging male population. As the extent of CAD increases, the prevalence and severity of erectile dysfunction and LUTS increase. We highly recommend that men older than 40 who complain of erectile dysfunction and LUTS be evaluated for CAD.