Prevalence and Association between Erectile Dysfunction and Coronary Artery Disease

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Prevalence and Association between Erectile Dysfunction and Coronary Artery Disease Terdsak Cherdshoo MD, Paiboon Chotiparatpat MD, and Anawat Sermswan MD Division of Cardiology, Department of

1 Prevalence and Association between Erectile Dysfunction and Coronary Artery Disease Terdsak Cherdshoo MD, Paiboon Chotiparatpat MD, and Anawat Sermswan MD Division of Cardiology, Department of Medicine, BMA Medical College and Vajira Hospital, Bangkok. Thailand Abstract Background: As atherosclerosis is a systemic disorder, penile circulation might be involved similarly, as in the coronary circulation. In the West, prevalence of Erectile Dysfunction (ED) is as high as 75% and has been reported in established Coronary Artery Disease (CAD) but this association is t yet kwn for Thai patients. Objective: To investigate the prevalence and correlation between ED and CAD according to clinical presentation and extension of epicardial vessel involvement Methods: 160 patients who came to the hospital due to chest pain, were devided into four groups defined according to clinical presentation and angiographic results [Normal CAG or n-obstructive CAD (NOCAD), acute coronary syndrome (ACS) single vessel disease, ACS multi-vessel disease, chronic stable angina]. All of them were evaluated for ED by the erectile function domain of the International Index of Erectile Function (IIEF-EFD), a validated 5-item self administered questionnaire. Variable data was compared by the Chi square and Fisher s Exact Test and the relationship between ED prevalence, clinical presentation and extension of CAD was analyzed by multivariate logistic regression. Results: Patients with established CAD had a significantly higher rate of ED than the NOCAD or rmal CAG group [90.4% VS 54.2%, OR 8.01, 95%CI , p < ]. Among the ACS groups, ACS multi-vessel group had a significantly higher rate of ED than the ACS single vessel group [97.1% VS 77.1% OR 9.96, 95%CI ( ), p = 0.001]. We found that the chronic stable angina group had a significantly higher rate of ED than the ACS single group (Fisher s Exact p = 0.026) but t different from the ACS multi-vessel group (Fisher s Exact p = 1.00). Multivariate logistic regression analysis (adjusting for age, diabetes mellitus, beta-blocker use, left ventricular ejection fraction) demonstrated that ED was significantly related to CAD [OR 6.48, 95%CI ( ), p = 0.001]. Conclusion: ED was significantly related to CAD. Prevalence of ED was different across subsets of CAD defined according to clinical presentation and extension of vessel involvement. Key words: erectile dysfunction, acute coronary syndrome, chronic stable angina Thai Heart J 2011; 24 (Suppl. 1) : S16-25 E-Journal : Introduction Erectile dysfunction (ED) is the inability of a man to maintain a firm erection long eugh to have sex. Although ED is more common in older men, this common problem can occur at any age. Having trouble maintaining an erection from time to time isn t necessarily a cause for Correspondence: Terdsak Cherdshoo, MD Division of Cardiology, Department of Medicine, BMA Medical College and Vajira Hospital, Bangkok, Thailand Tel , , Fax E mail address: terd_terdsak@hotmail.com concern. But if the problem is ongoing, it can cause stress and relationship problems and affect self-esteem. ED is t an uncommon medical problem. Epidemiologic studies have reported that there are about more than 300 million men worldwide with ED. In the USA, ED has been reported to afflict, to some degree, 52% of male adults between the ages of 40 and 70 years. The prevalence of ED was as high as 75% in patients with established coronary artery disease (CAD)(1-4). In Thailand, the TEDES (Thai Erectile Dysfunction Epidemiologic Study Group) reported the prevalence of ED in The study had a major aim to estimate the prevalence of ED in the country. A nationwide representative sample of 1,250 urban Thai men between THAI HEART JOURNAL Vol. 24 Suppl. 1 April 2010

2 Terdsak Cherdshoo MD 40 to 70 years was used. The estimation of the overall prevalence of ED among the respondents living in urban areas was 37.5%. This proportion consisted of 19.1% of males with mild ED, while about 13.7% and 4.7% of the samples had moderate and severe dysfunction. Moreover, results of this study indicated that when men become older, they have a greater likelihood of suffering from ED and the prevalence rate of ED rapidly increased from the age group years to years (5). There are many causes of ED. Male sexual arousal is a complex process involving the brain, hormones, emotions, nerves, muscles and blood vessels. If something affects any of these systems-or the delicate balance among them -ED can result. Common causes of ED include heart disease, clogged blood vessels (atherosclerosis), hypertension, diabetes, obesity and metabolic syndrome (6). A variety of risk factors can contribute to ED. They include: Getting older. As many as 80 percent of men 75 and older have ED. ED often occurs in older men mainly because they are more likely to have underlying health conditions or take medications that interfere with erectile function. Having a chronic health condition. Diseases of the lungs, liver, kidneys, heart, nerves, arteries or veins can lead to ED. So can endocrine system disorders, particularly diabetes. The accumulation of deposits (plaques) in arteries (atherosclerosis) also can prevent adequate blood from entering the penis. In some men, ED may be caused by low levels of testosterone (male hypogonadism). Taking certain medications. A wide range of drugs- including antidepressants, antihistamines and medications to treat high blood pressure, pain and prostate cancer- can cause ED by interfering with nerve impulses or blood flow to the penis. Tranquilizers and sleeping aids also can pose a problem. Certain surgeries or injuries. Damage to the nerves that control erections can cause ED. This damage can occur if you injure your pelvic area or spinal cord. Surgery to treat bladder, rectal or prostate cancer can increase your risk of ED. Substance abuse. Chronic use of alcohol, marijuana or other drugs often causes ED and decreases sexual drive. S17 Stress, anxiety or depression. Other psychological conditions also contribute to some cases of ED. Smoking can cause ED because it restricts blood flow to veins and arteries. Men who smoke cigarettes are much more likely to develop ED (6-10). Atherosclerosis is a systemic disorder. Therefore, penile circulation might be involved similarly as in the coronary circulation. There are several studies which suggest that ED is frequently an earlier presentation prior to CAD. However, this may need more studies to support the fact that ED might be an indicator of CAD (11-14). The main objectives of this study were 1) to investigate the prevalence of ED in patients with CAD and 2) to investigate the association between ED and CAD. A secondary objective was to investigate the prevalence of ED according to clinical presentation and extension of vessel involvement and to investigate the association between the severity of CAD and degree of ED. Methods Patients This study was approved by the institutional Ethics Committee of Vajira Hospital. All patients signed informed consents. 160 patients who came to Vajira hospital from January to December, 2008 because of cardiac chest pain that was compatible with acute coronary syndrome (ACS) or chronic stable angina and underwent coronary angiography were enrolled. Before discharge, Patients were asked to answer an erectile function questionnaire assessment. In combination with angiographic data, clinical presentation and ED questionnaire assessment results, patients were classified into four groups which consisted of: 1. ACS with rmal coronary angiogram or bstructive CAD (defined as coronary intraluminal stesis < 50%) 2. ACS, single vessel disease 3. ACS, multi-vessel disease (2 or 3 vessel involvement) 4. Chronic stable angina Inclusion Criteria Inclusion criteria consisted of the following: 1. Male 75 years or less. 2. All of the patients came to the hospital due to cardiac chest pain which was compatible with ACS or chronic stable angina. THAI HEART JOURNAL Vol. 24 Suppl. 1 April 2011

3 S18 3. Undergoing coronary angiography. 4. Agreed to answer the International Index of Erectile Function (IIEF) questionnaire assessment. Exclusion All of the following were excluded: > 75 years of age, inactive sexual function, history of trauma to the pelvis, perineum, genitalia and spinal cord injury, history of colorectal surgery, radical prostatectomy, orchidectomy, pelvic radiation, urinary incontinence, current use of centrally acting antihypertensive drugs, antiandrogens, estrogens, or narcotic drugs. ED questionnaire assessment ED was assessed by the erectile function domain of the International Index of Erectile Function (IIEF-EFD), which is a questionnaire assessment that consists of 5 questions. Each question was scored ranging from 1 to 5, with the total possible score summation of 25. This scoring system was reported by RC Rosen et al, which was published in the International Journal of Impotent research in They found that if the Cut-off point was 21, this questionnaire had a sensitivity of 98% and a specificity of 88% (15-17). Prevalence and Association between Erectile Dysfunction and Coronary Artery Disease ED was established if the score summation was below 21. The degree of ED was classified as mild (Score 17-20), mild to moderate (Score 11-16), moderate (Score 8-10), and severe (Score < 7). Statistical analysis This is cross-sectional descriptive study; the variable data were analyzed by the chi-square and Fisher s exact test. The association between ED and CAD was assessed by multivariable logistic regression analysis. Results 160 patients that came to Vajira hospital from January to December, 2008 and were undergoing coronary angiography were classified according to clinical presentation and extension of coronary vessel involvement into four groups. There were 24 patients in the group with ACS with rmal coronary angiography or n-obstructive CAD, 48 patients in the group with ACS single vessel disease, 69 patients in the group with ACS multi-vessel disease and 19 patients in the group with chronic stable angina (Figure 1 and 3). Figure 1. Flow of study THAI HEART JOURNAL Vol. 24 Suppl. 1 April 2010

Terdsak Cherdshoo MD S19 Table 1. Clinical characteristics of study population Characteristics Age (Years) 55 yrs. 56-70 yrs. 71-75 yrs. Alcoholic drinking No Yes Smoking 59 75 26 129 31 93 67 36.

4 Terdsak Cherdshoo MD S19 Table 1. Clinical characteristics of study population Characteristics Age (Years) 55 yrs yrs yrs. Alcoholic drinking No Yes Smoking % 46.90% 16.30% 80.60% 19.40% 58.10% 41.90% Family History of premature CAD Hypertension DM Dyslipidemia % 9.40% 21.90% 78.10% 65.60% 34.40% 41.90% 58.10% 3 RF or more (smoking, family history, DM, HT, DLP) Total (n = 160) % % Normal (n = 24) % % % % % % % % % % % % % % % % % ACS single vessel (n = 48) % % % % % % % % % % % % % % % % % ACS multi-vessel (n = 69) % % % % % % % % % % % % % % % % % Chronic stable angina (n = 19) % % % % % % % % % % % % % % % % % * Significant at p = 0.05, Y = p-value from Chi-Square test ACS = acute coronary syndrome, CAD = coronary artery disease, DM = diabetes mellitus, HT = hypertension, DLP = dyslipidemia p-value (Y) = 0.018* * 0.003* Figure 2. Percentage of patients according to clinical presentation and extension of coronary vessel involvement THAI HEART JOURNAL Vol. 24 Suppl. 1 April 2011

5 S20 Prevalence and Association between Erectile Dysfunction and Coronary Artery Disease Table 2. Drug Use Current medications of study population prior to data collection Aspirin Use Beta blocker Use ACEI or ARB Use Ca channel blocker Use Statin Use Oral hypoglycemic agent Use LV EF <40% 40-60% >60% Total (n = 160) % % % % % % % % % % % % % % % Normal (n = 24) % % % % % % % % % % % % % % % ACS single vessel (n = 48) % % % % % % % % % % % % % % % ACS multi-vessel (n = 69) % % % % % % % % % % % % % % % Chronic stable angina (n = 19) % % % % % % % % % % % % % % % p-value 0.001* 0.005* 0.013* * Significant at p = 0.05, Y = p-value from Chi-Square test ACS = acute coronary syndrome, ACEI = angiotensin converting enzyme inhibitor, ARB = angiotensin receptor blocker, LVEF = left ventricular ejection fraction All of the patients were assessed for erectile function status by the IIEF-questionnaire assessment. The ED degree status is shown in Figure 3. The clinical characteristic of the study population are listed in table 1 by age group, alcohol drinking, smoking, family history of premature CAD, hypertension (HT), diabetes, dyslipidemia, multiple risk factors ( 3 risk factors: smoking, family history, DM, HT, DLP), and baseline ejection fraction. The current medication of patients were checked which consisted of aspirin, β-blockers, angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, calcium channel blockers, and oral hypoglycemic agents (Table 2). This study showed that patients with established CAD had a significantly higher prevalence of ED more than the NOCAD or rmal CAG group (90.4% VS 54.2%), OR 8.01, 95% CI p < , as shown in Figure 4. In a subgroup analysis, among the ACS groups - the study showed that the ACS multi-vessel group had a significantly higher rate of ED than the ACS single vessel group (97.1% VS 77.1%), OR 9.96, 95% CI ( ), p = Moreover, the chronic stable angina group, had a significantly higher rate of ED than the ACS single vessel group (Fisher s Exact p = 0.026) but was t different from the ACS multi-vessel group (Fisher s Exact p = 1.00) as shown in Figure 5. THAI HEART JOURNAL Vol. 24 Suppl. 1 April 2010

Terdsak Cherdshoo MD S21 Table 3. Association between ED and CAD according to degree of ED and clinical presentation and extension of vessel involvement.

00% 35 21.90% 35 21.90% 37 23.10% 29 18.10% 11 45.80% 5 20.80% 5 20.80% 1 4.20% 2 8.30% 11 22.90% 26 54.20% 7 14.60% 1 2.10% 3 6.30% 2 2.90% 3 4.30% 23 33.30% 24 34.80% 17 24.60% 0 0.00% 1 5.30% 0 0.

Prevalence of ED in CAD and NOCAD group Furthermore, the study found that the prevalence of ED and its degree of severity were different in subgroups of CAD.

6 Terdsak Cherdshoo MD S21 Table 3. Association between ED and CAD according to degree of ED and clinical presentation and extension of vessel involvement. Erectile Dysfunction Total (n = 160) Normal (n = 24) ACS single vessel (n = 48) ACS multi-vessel (n = 69) Chronic stable angina (n = 19) p-value ED mild mild to moderate moderate severe % % % % % % % % % % % % % % % % % % % % % % % % % <0.001 * Significant at p = 0.05, Y = p-value from Chi-Square test ACS = acute coronary syndrome, ED = erectile dysfunction Figure 3. Degree of ED in study population Figure 4. Prevalence of ED in CAD and NOCAD group Furthermore, the study found that the prevalence of ED and its degree of severity were different in subgroups of CAD. The groups with NOCAD and ACS single vessel tended to have a higher prevalence in the mild degree of ED or ED at all. In contrast, the groups with ACS multi vessel and chronic stable angina tended to have a higher prevalence in the moderate or severe degree of ED. These associations were statistically significant; p value was as shown in Table 3 and Figure 6, 7. The multivariate analysis, adjusting for the confounding factors that included age, DM, beta blocker use and ejection fraction found that ED was significantly related to CAD, Odds ratio = 6.48 and p value 0.001, 95%CI 2.18, 19.32, as shown in Table 4. Figure 5. Prevalence of ED in subgroup analysis, A line, B line, C line (A = ACS multivessel > ACS single vessel, 97.1% VS 77.1%, OR 9.96, 95% CI ( ), p = 0.001], B = chronic stable angina > ACS single, 100% VS 77.1%, [Fisher s Exact p = 0.026], C = chronic stable angina ~ ACS multivessel, 100% VS 97.1%, [Fisher s Exact p = 1.00]) THAI HEART JOURNAL Vol. 24 Suppl. 1 April 2011

7 S22 Table 4. Multivariate analysis of the association between risk factors and CAD Prevalence and Association between Erectile Dysfunction and Coronary Artery Disease 95% CI of OR Variables n OR Lower Upper p-value Age (Years) < 55 yrs. 59 Ref (1) yrs yrs Diabetes mellitus 105 Ref (1) Beta blocker Use 79 Ref (1) Erectile Dysfunction 24 Ref (1) * LVEF < 40% 20 Ref (1) 40-60% > 60% p-value from Binary Logistic regression, * significant at p-value = 0.05 OR = Odds ratio, LVEF = left ventricular ejection fraction Figure 6. Association between erectile dysfunction and CAD according to degree of ED and clinical presentation and extension of vessel involvement. THAI HEART JOURNAL Vol. 24 Suppl. 1 April 2010

Terdsak Cherdshoo MD S23 Figure 7. Association between erectile dysfunction and CAD according to degree of ED and clinical presentation and extension of vessel involvement.

8 Terdsak Cherdshoo MD S23 Figure 7. Association between erectile dysfunction and CAD according to degree of ED and clinical presentation and extension of vessel involvement. Discussion Prevalence of ED in patients with established CAD This was a pilot study to investigate the prevalence of ED in Thai male patients with established CAD. The prevalence of ED in this study was higher than the prevalence of ED in reference studies (90.4% in this study and around 75% in reference studies)(1-4). This difference might be due to differences in the age of enrolled patients. In the reference study, the enrolled age of patients was years and their mean age was around years old. But in this study, the age of enrolled patients was less than 75 years, with 16% of patients between years. All of them had some degree of ED and established CAD. Association between ED and CAD according to clinical presentation ACS is mainly due to abrupt closure of a previous single vessel with ncritical stesis in an otherwise rmal coronary tree without additional critical lesions. This means a low atherosclerotic burden pattern. Conversely, chronic stable angina is usually due to significant coronary stesis frequently involving multiple arteries and sites and that means a high atherosclerotic burden pattern. ED is an atherosclerotic disease. Therefore in the case of a higher atherosclerotic burden pattern maybe one reason for a higher prevalence of ED. Limitations of study 1) This study was observational in nature. So, some variables were difficult to control such as angiographic data interpretation. 2) ED was assessed by a questionnaire (the International Index of ED) which had a sensitivity of 98% and a specificity of 88%. However, the sensitivity and specificity were established and studied in the United States and United Kingdom. There are differences in culture between Thai people and people from both those countries. Thai patients may be more embarrassed to talk with their doctor about sexual issues. So, some Thai patients might t be forthcoming about some answers. 3) Some questions were dependent on the satisfaction and recall of the patients. Benefits 1) In general, this study might indicate and remind us that ED is a common problem in patients with established THAI HEART JOURNAL Vol. 24 Suppl. 1 April 2011

9 S24 CAD. So, doctors should be attentive to the problem which the patient is embarrassed to talk about with them. 2) In patients who come to the hospital because of ED may actually have asymptomatic CAD. So, this might prompt the doctor to look for coronary and atherosclerotic risk factors in their patients. 3) Furthermore, this might be a precursor for a pilot study to show that ED is an additional index to identify CAD progsis which requires more support in future studies. Conclusion This study showed a high prevalence of ED in Thai patients with established CAD. ED was significantly related to CAD. Prevalence of ED was different across subsets of CAD defined according to clinical presentation and extension of vessel involvement. Ackwledgements The author is greatly indebted to all patients who participated in this research and Thaveekiat Wasawakul, MD and Watana Boonsom, MD for critically reading the manuscript and helpful discussions. And lastly to all staff at the cardiac catheterization unit and all nurses in the chest pain unit of Vajira hospital for data collection. Conflict of Interest None References 1. Russell ST, Khandheria BK, Nehra A. Erectile dysfunction and cardiovascular disease. Mayo Clinic proceedings 2004; 79: Prins J, Blanker MH, Bohnen AM, Thomas S, Bosch JL. Prevalence of erectile dysfunction: a systematic review of population-based studies. International journal of impotence research 2002; 14: Kaye JA, Jick H. Incidence of erectile dysfunction and characteristics of patients before and after the introduction of sildenafil in the United Kingdom: cross sectional study with comparison patients. BMJ 2003; 326: Montorsi P, Ravagnani PM, Galli S, et al. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J 2006; 27: An epidemiological study of erectile dysfunction in Thailand (Part 1: Prevalence). Thai Erectile Dysfunction Epidemiologic Study Group (TEDES). J Med Assoc Thai 2000; 83: Prevalence and Association between Erectile Dysfunction and Coronary Artery Disease 6. Esposito K, Giuglia F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. Jama 2004; 291: McVary KT. Clinical practice. Erectile dysfunction. N Engl J Med 2007; 357: Gazzaruso C, Giordanetti S, De Amici E, et al. Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation 2004; 110: Jackson G. Erectile dysfunction: a marker of silent coronary artery disease. Eur Heart J 2006; 27: Cheitlin MD. Erectile dysfunction: the earliest sign of generalized vascular disease? JACC 2004; 43: Foroutan SK, Rajabi M. Erectile dysfunction in men with angiographically documented coronary artery disease. Urol J 2007; 4: Montorsi P et al, Erectile dysfunction predicted extension of coronary artery disease by angiography in acute coronary syndrome, AUA Oct 20, Vlachopoulos C, Rokkas K, Ioakeimidis N, et al. Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study. European urology 2005; 48: ; discussion Solomon H, Man JW, Wierzbicki AS, Jackson G. Relation of erectile dysfunction to angiographic coronary artery disease. Am J Cardiol 2003; 91: Rhoden EL, Teloken C, Sogari PR, Vargas Souto CA. The use of the simplified International Index of Erectile Function (IIEF- 5) as a diagstic tool to study the prevalence of erectile dysfunction. International journal of impotence research 2002; 14: Chang SC, Chen KK, Chang LS. Evaluation of Erectile Dysfunction Using the International Index of Erectile Function- 5 (IIEF-5) in 200 Urological Patients. J Urol ROC 2000; 11: Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagstic tool for erectile dysfunction. International journal of impotence research 1999; 11: THAI HEART JOURNAL Vol. 24 Suppl. 1 April 2010

10 Terdsak Cherdshoo MD S25 ความช กและความส มพ นธ ระหว างภาวะเส อมสมรรถภาพทางเพศก บโรคหลอดเล อดห วใจ เท ดศ กด เช ดช, อนว ช เสร มสวรรค, ไพบ ลย โชต นพร ตน ภ ทร บทค ดย อ เบ องหล ง: หลอดเล อดต บ ม ผลทำให การไหลเว ยนเล อดผ ดปกต และสามารถเก ดข นได ก บหลอดเล อดท วร ายกาย รวมท ง หลอดเล อดห วใจ และหลอดเล อดท ไปเล ยงอว ยวะส บพ นธ ในต างประเทศพบว าความช กของภาวะเส อมสมรรถภาพทางเพศ ในผ ป วยโรคหลอดเล อดห วใจ ส งถ ง 75% ซ งย งไม ม ข อม ลในคนไทย ว ตถ ประสงค : เพ อหาความช กของภาวะเส อมสมรรถภาพทางเพศในผ ป วยโรคหลอดเล อดห วใจในคนไทย และหาความ ส มพ นธ ระหว างภาวะด งกล าว โดยแบ งตามอาการนำและจำนวนหลอดเล อดห วใจท ต บ ว ธ ดำเน นงาน: ผ ป วย 160 รายท มารพ.ด วยอาการเจ บหน าอก ถ กแบ งออกเป น 4 กล มตามอาการนำและผลการฉ ดส สวนหลอด เล อดห วใจ ค อ 1.ไม ม หลอดเล อดห วใจต บ 2. ม อาการเจ บหน าอกแบบเฉ ยบพล น และม หลอดเล อดห วใจต บเพ ยงเส นเด ยว 3. ม อาการเจ บหน าอกแบบเฉ ยบพล น และม หลอดเล อดห วใจต บหลายเส น 4.ม อาการเจ บหน าอกแบบเร อร ง ผ ป วยท กราย ได ร บการประเม นภาวะเส อมสมรรถภาพทางเพศโดยใช แบบสอบถาม แล วนำมาหาความช กและความส มพ นธ ในเช งสถ ต ผลการศ กษา: พบว า ผ ป วยท ม หลอดเล อดห วใจต บม ภาวะเส อมสมรรถภาพทางเพศ มากกว ากล มท ไม ม หลอดเล อดห วใจ ต บอย างม น ยสำค ญ (90.4 % และ 54.2% ตามลำด บ, ค าส มประส ทธ 8.01เท า,โดยม ค า 95% ความเช อม น ระหว าง , p < ) ส วนในกล มผ ป วยหลอดเล อดห วใจต บด วยก น พบว ากล มท ม หลอดเล อดต บหลายเส นม ภาวะเส อมสมรรถภาพ ทางเพศมากกล มท หลอดเล อดต บเพ ยงเส นเด ยวอย างม น ยสำค ญ (97.1% และ 77.1% ตามลำด บ,ค าส มประส ทธ 9.96,โดยม ค า95%ความเช อม น ระหว าง , ค าพ = 0.001) แต พบว าความช กของภาวะเส อมสมรรถภาพทางเพศระหว างผ ป วย เจ บหน าอกเฉ ยบพล นท ม หลอดเล อดห วใจต บหลายเส น ไม แตกต างก บกล มผ ป วยอาการเจ บหน าอกเร อร ง การว เคราะห ทาง สถ ต แบบถดถอยท ม หลายต วแปร แสดงให เห นว าภาวะเส อมสมรรถภาพทางเพศม ความส มพ นธ ก บภาวะหลอดเล อดห วใจ ต บอย างม น ยสำค ญ (ม ค าส มประส ทธ 6.48 เท า, โดยม ค า95%ความเช อม น ระหว าง , ค าพ = 0.001) บทสร ป: ภาวะเส อมสมรรถภาพทางเพศม ความส มพ นธ ก บภาวะหลอดเล อดห วใจต บ โดยแต ละกล มม ความช กของภาวะเส อม สมรรถภาพทางเพศแตกต างก น THAI HEART JOURNAL Vol. 24 Suppl. 1 April 2011

Abstract. Introduction. Kitigon Vichairuangthum, MD 1, Anawat Sermsawan, MD 1, and Mala Treewatchareekorn, MSc 2

Abstract. Introduction. Kitigon Vichairuangthum, MD 1, Anawat Sermsawan, MD 1, and Mala Treewatchareekorn, MSc 2 Troponin I Assessment Provides Incremental Prognostic Information in Patients with Acute Coronary Syndromes and Borderline Troponin T Values upon Admission Kitigon Vichairuangthum, MD 1, Anawat Sermsawan,