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Men with diabetes have a higher prevalence of erectile dysfunction (ED) compared to the general population. ED is one of the major sources of stress for men with diabetes. Apart from interfering with sexual life, ED is associated with the presence of heart diseases. In a study of men with type 2 diabetes, ED was found to be an important early warning sign of serious heart diseases including heart attack and death. The research, which will be published in the 27 May 2008 issue of the Journal of the American College of Cardiology (JACC), highlights the importance of encouraging men with diabetes to report ED to their physicians.

Over 2,300 men with type 2 diabetes were followed up for 4 years. During the annual check-up for diabetic complications, men were asked the question “Do you have problems with erection?” ED was defined as the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance. 27% of the men admitted having problems of erection. During the study period, 123 men suffered a heart attack, died from heart disease, developed chest pain from blocked arteries in the heart, or needed bypass surgery or a catheter intervention to restore blood flow to the heart muscle. Out of every 1,000 men with diabetes and ED, 19.7 could be expected to experience a coronary heart disease (CHD) event every year, as compared to only 9.5 of 1,000 men without ED.

“ED is a powerful predictor of coronary heart disease,” said Prof. Ronald Ma, Associate Professor in the Department of Medicine & Therapeutics at The Chinese University of Hong Kong (CUHK). “In the analysis of the association between ED and CHD, we included many known risk factors of cardiovascular diseases, such as age, high blood pressure, smoking, duration of diabetes, the need for cholesterol- or blood pressure-lowering drugs, and damage to the eyes or the kidneys as a result of diabetes. Even after taking all these factors into consideration, ED remained an independent early warning sign of CHD with a 58% increase in the risk.”

“This is an important study for our patients with diabetes. For the first time, we demonstrate that ED predicts future adverse heart events after controlling other cardiovascular risk factors. Therefore, the presence of ED should alert both patients and doctors to address modifiable risk factors such as poor glycaemic control, high blood pressure, high cholesterol levels, smoking and obesity aggressively,” continued Prof. Ma.

“Sexual dysfunction is always an embarrassing problem for both patients and doctors to discuss,” commented Prof. Peter Tong, Director of the Yao Chung Kit Diabetes Assessment Centre, CUHK. “Given our results on the importance of ED in predicting future heart problems, the issue should be raised during medical consultation. There are structured questionnaires such as the 5-item version of the International Index of Erectile Dysfunction (IIEF-5) that are useful in assessing the severity of the problem. Our findings also highlight the importance of having regular assessment for diabetic complications, so that ED, foot problems, damages to the eyes and the kidneys can be identified and treated without delay. By alerting patients and their doctors early, these risk assessment programs can be potentially life-saving,” continued Prof. Tong.

“At present, many subjects with diabetes are not aware of the presence of these devastating complications. Without prompt attention, death, heart attack, stroke, blindness, leg amputation and kidney failure will occur. At least for men, those with erectile dysfunction should immediately undergo a comprehensive assessment of diabetic complications, so that bad cardiovascular risk factors can be identified and treated aggressively,” remarked Prof. Tong.

The silent nature of diabetes, the lack of awareness and resources imply that many patients with diabetes have never been properly assessed for diabetic complications. The establishment of the Yao Chung Kit Diabetes Assessment Centre at CUHK in March 2008, made possible with the generous donation of HK$28 million by the Yao Yiu Sai Education and Charitable Memorial Fund, provides an accessible and affordable comprehensive diabetes assessment program based on international standards. Based on the result of the assessment, people with diabetes and their health care team are able to make informed decisions of their subsequent care plan.

Details on the Yao Chung Kit Diabetes Assessment Centre, CUHK are as follows:
Telephone Number: 2647 8806
Fax Number: 2947 8495
Website : http://yckdac.hkido.cuhk.edu.hk
E-mail : yckdac@cuhk.edu.hk