Abstract
Although the origin of cardiac syndrome X (CSX) is still debated, endothelial dysfunction leading to reduced coronary microvascular dilatory response and increased coronary resistance is thought to have an important role in the pathogenesis. Erectile dysfunction (ED) is associated with risk factors resulting in endotelial dysfunction. Although the relationship between cardiovascular disease and ED has been well established; the relation between CSX and ED has not been extensively studied so far. We herein aimed to study ED in patients with CSX. The study was designed as a prospective case–control study. Blood samples were analyzed with respect to concentrations of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides. The subjects answered the native language five-item version of the International Index of Erectile Function Questionnaire (IIEF)-5. Each question was scored from 0 to 5 with a maximum score of 25 denoting healty subjects. We investigated the IIEF-5 score in 51 men with CSX (mean age=48.2±6.4 years), 53 men with demonstrated coronary artery disease (CAD) (mean age=48.3±4.8 years) and 52 male controls with normal coronary arteries (mean age=47.2±6.0 years). Mean IIEF-5 scores were 19.88±3.07 for CSX group, 18.83±3.31 for CAD group and 21.40±2.94 for control group. IIEF-5 scores in CSX group were found to be significantly lower than the those of control group (P<0.001). There were no significant differences in IIEF-5 scores between CSX and CAD groups (P=0.09). We have shown for the first time that patients with CSX have lower IIEF-5 scores compared with controls with normal coronary angiograms. This study suggests that ED and CSX may be different manifestations of a common underlying vascular pathology and vasculogenic ED is frequently seen in CSX at least as much as in CAD.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 8 print issues and online access
$259.00 per year
only $32.38 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Pantin J, Gatehouse P, Yang G, Grothues F, Firmin DN, Collins P et al. Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging. N Engl J Med 2002; 346: 1948.
Kemp H . Left ventricular function in patients with the anginal syndrome and normal coronary arteriograms. Am J Cardiol 1973; 32: 6.
Anon. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993; 270: 83–90.
Carson CC . Vascular risk factors for erectile dysfunction. J Urol 2007; 178: 2250–2251.
Virag R, Bouilly PFD . A study of arterial risk factors in 440 impotent men. Lancet 1985; 1: 184.
Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM . Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impotence Res 1999; 11: 319–326.
Al Suwaidi J, Higano S, Holmes DJ, Lerman A . Pathophysiology diagnosis, and current management strategies for chest pain in patients with normal findings on angiography. Mayo Clin Proc 2001; 76: 813–822.
Panting JR, Gatehouse PD, Yang GZ, Grothues F, Firmin DN, Collins P et al. Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonanceimaging. N Engl J Med 2002; 346: 1948–1953.
Kolasińska-Kloch W, Leśniak W, Kieć-Wilk B, Malczewska-Malec M . Biochemical parameters of endothelial dysfunction in cardiological syndrome X. Scand J Clin Lab Invest 2002; 62: 7–13.
McKinlay J . The worldwide prevalence and epidemiology of erectile dysfunction. Int J Impot Res 2000; 12 (Suppl 4): 6–11.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB . Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54.
Moncada S, Palmer R, Higgs E . Nitric oxide: physiology, pathophysiology, and pharmacology. Pharmacol Rev. 1991; 43: 109–142.
Masuda H . Significance of nitric oxide and its modulation mechanisms by endogenous nitric oxide synthase inhibitors and arginase in the micturition disorders and erectile dysfunction. Int J Urol 2008; 15: 128–134.
Gratzke C, Angulo J, Chitaley K, Dai YT, Kim NN, Paick JS et al. Anatomy, physiology, and pathophysiology of erectile dysfunction. J Sex Med 2010; 7 (1 pt 2): 445–475.
Sen N, Poyraz F, Tavil Y, Yazici HU, Turfan M, Hizal F et al. Carotid intima-media thickness in patients with cardiac syndrome X and its association with high circulating levels of asymmetric dimethylarginine. Atherosclerosis 2009; 204: e82–e85.
Agarwal A, Nandipati KC, Sharma RK, Zippe CD, Raina R . Role of oxidative stress in the pathophysiological mechanism of erectile dysfunction. J Androl 2006; 27: 335–347.
El Melegy NT, Ali M-EM, Awad EM . Plasma levels of endothelin-1, angiotensin II, nitric oxide and prostaglandin E in the venous and cavernosal blood of patients with erectile dysfunction. BJU Int 2005; 96: 1079–1086.
Barassi A, Colpi G, Piediferro G, Dogliotti G, D'Eril GV, Corsi MM et al. Oxidative stress and antioxidant status in patients with erectile dysfunction. J Sex Med 2009; 6: 2820–2825.
Gur M, Yildiz A, Demirbag R, Yilmaz R, Aslan M, Ozdogru I et al. Paraoxonase and arylesterase activities in patients with cardiac syndrome X, and their relationship with oxidative stress markers. Coron Artery Dis 2007; 18: 89–95.
Atmaca Y, Ozdol C, Turhan S, Vurgun K, Duzen V, Erol C et al. The association of elevated white blood cell count and C-reactive protein with endothelial dysfunction in cardiac syndrome X. Acta Cardiol 2008; 63: 723–728.
Tousoulis D, Davies G, Asimakopoulos G, Homaei H, Zouridakis E, Ahmed N et al. Vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 serum level in patients with chest pain and normal coronary arteries (syndrome X). Clin Cardiol 2001; 24: 301–304.
Tondi P, Santoliquido A, Di Giorgio A, Sestito A, Sgueglia GA, Flore R et al. Endothelial dysfunction as assessed by flow-mediated dilation in patients with cardiac syndrome X: role of inflammation. Eur Rev Med Pharmacol Sci 2011; 15: 1074–1077.
Nurkalem Z, Kaya C, Orhan AL, Zencirci E, Alper AT, Kucuk E et al. Erectile dysfunction and coronary slow flow: distinct presentations of endothelial disease. Int J Impot research 2007; 19: 610–614.
Akcay AB, Inci M, Bilen P, Acele A, Sen N, Yalcin F et al. Assessment of the relationship between coronary artery ectasia and erectile function score. Int J Impot Res 2011; 23: 128–133.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Demirkol, S., Balta, S., Kucuk, U. et al. Association between microvascular angina and erectile dsyfunction. Int J Impot Res 26, 124–127 (2014). https://doi.org/10.1038/ijir.2013.49
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ijir.2013.49
Keywords
This article is cited by
-
The spectrum and systemic associations of microvascular dysfunction in the heart and other organs
Nature Cardiovascular Research (2022)
-
Post-challenge insulin concentration is useful for differentiating between coronary artery disease and cardiac syndrome X in subjects without known diabetes mellitus
Diabetology & Metabolic Syndrome (2017)
-
Coronary microvascular dysfunction: sex-specific risk, diagnosis, and therapy
Nature Reviews Cardiology (2015)