Underestimated: Erectile dysfunction in patients with ascending aortic disease

Objectives: Erectile dysfunction (ED) is correlated with cardiovascular disease (CVD) in general and following abdominal aortic surgery in particular. Little is known about ED in patients with ascending aorta disease (AAD).

Methods: Following repair of the ascending aorta male patients were asked about risk factors, ED, libido deficiency (LD), reproductive history and hormone disorders. The response of 330 men with a follow-up of 6.4 ± 3.1ys (1.8-12.5ys) were compared to an age-matched control group of 100 men (age 66.2 ± 12.0 ys and 66.2 ± 13.0 yrs, p = 0.934; body mass index 27.7 ± 5.1 vs 27.1 ± 3.8 p = 0.454; diabetes mellitus 12.1% vs 10.2%, p = 0.720; peripheral arterial disease 3.6% vs 5.4%, p = 0.543; carotid disease 6.8% vs 8.7%, p = 0.646).

Results: Compared to the matched control group, males with AAD were twice as commonly affected by ED (48.0% vs 22.8%, p = 0.001) and had significantly more LD (42.9% vs 27.2%, p = 0.007). No relevant difference in admitting ED was found in patients with aortic aneurysm as compared to aortic dissection (p = 0.105). No impact was found on ED or LD by the surgical procedure including coronary artery bypass graft (CABG) and valve procedures. Males with AAD more often received CABG (16.2%, all with aortic surgery except one patient, vs 3.4%, p = 0.001), however, percutaneous coronary intervention (PCI) was less commonly observed (5.4% vs 16.3%, p = 0.001) compared to controls. Interestingly, males with AAD were less frequently found to be smokers than controls, but males with AAD more commonly had a previous smoking history (current 6.1% vs 17.0%, p = 0.001; additive previous and current 27.4%, p = 0.022). Hypertension and hypercholesterolemia were more prevalent in AAD (87.7% vs 47.5%, p < 0.001; and 46.4% vs 33.0%, p = 0.012). Independently, a strong correlation exists between NYHA and ED (I 33.3%, II 48.8%, III 63.9%, and IV 66.7%; p < 0.001). Aortic patients presented in worse NYHA status compared to controls (I 26.3% vs 45.9%, II 45.3% vs 38.8%, III 25.6% vs 14.3%, and IV 2.4% in both groups; p = 0.002). Comparing males with AAD to controls, no differences were seen in reproductive history and hormone disorders.

Conclusions: The high prevalence of ED in patients with ascending aortic disease may be an expression of cardiac insufficency as such or a marker of a population with a distinctive cardiovascular risk profile. More awareness of this association is required for the implementation of appropriate treatment concepts to address this sensitive subject.