# Prevalence and Clinical Severity of Erectile Dysfunction in Patients Undergoing Coronary Angiography: A Descriptive Cross-Sectional Study at a Tertiary Hospital in Northern Sri Lanka

## TL;DR

This study found that erectile dysfunction is common in men undergoing heart tests and is linked to more severe heart disease, suggesting it could be an early warning sign.

## Contribution

The study establishes a strong link between ED severity and the extent of coronary artery disease in a Sri Lankan population.

## Key findings

- 60.7% of patients undergoing coronary angiography had erectile dysfunction.
- Severe ED was strongly associated with multi-vessel coronary artery disease.
- Hypertension and its duration were significantly linked to ED in bivariate analysis.

## Abstract

Background: Erectile dysfunction (ED) is an early clinical manifestation, and it could also be the "tip of the iceberg" of chronic atherosclerotic disease. As the onset of ED precedes major cardiovascular events, screening for it could be a simple and cost-effective approach for preventive management in low-income countries like Sri Lanka. This study aimed to determine the prevalence and clinical severity of ED among male patients undergoing coronary angiography, to assess the association between ED severity and the extent of coronary artery disease (CAD), and to examine relevant clinical risk factors.

Methods: A descriptive cross-sectional study was conducted among male patients undergoing coronary angiography at Teaching Hospital Jaffna, Sri Lanka, from July 2024 to October 2024. All eligible patients were recruited, which represents 73.9% (298) of the estimated sample. A structured interviewer-administered form was utilized to collect the data, which included a validated International Index of Erectile Function (IIEF)-5 questionnaire for assessing ED. Coronary angiography findings were used to assess the severity of CAD. IBM SPSS Statistics for Windows, Version 29 (Released 2021; IBM Corp., Armonk, New York, United States) was used to analyze the data.

Results: Out of 298 male patients who underwent coronary angiography during the study period, 181 were found to have ED (60.7%; CI: 55.1-66.2). There was a statistically significant association between ED severity and CAD extent (p-value < 0.001), particularly notable in patients with multi-vessel disease. The proportion of patients with severe ED (IIEF index = 4) showed an increased number of affected coronary vessels. Among patients with triple vessel disease, 82.5% (52 out of 63) had severe ED, while in patients with single-vessel disease and normal epicardial coronary vessels, severe ED was much less prevalent (5.7% and 4.9%, respectively) (Spearman-correlation r = 0.637, p-value < 0.001). The presence of hypertension was significantly associated with ED (p-value = 0.026) as well as the duration of hypertension (p-value = 0.034) in bivariate analysis. After adjustment for potential confounders, the results showed that diagnosed CAD was associated with a 3.92 times (CI: 2.2-7.03) higher risk of having ED.

Conclusion: This study demonstrated a strong association between ED and CAD, and it highlights that ED is an early indicator of underlying CAD. Routine screening for ED in high-risk patients, particularly those with hypertension and diabetes, can improve early detection of CAD and aid in the implementation of preventive strategies. However, the study's limitations, including its single-center design and cross-sectional nature, highlight the need for further multi-center and longitudinal research to validate these findings and explore the potential therapeutic benefits of ED management in cardiovascular disease.