May 31, 2007
Internal Medicine World Report, September 2006, Volume 0, Issue 0

New Data Linking ED to Heart Disease, Severity Varies by Extent of CAD

European Heart Journal

MILAN—The rate of erectile dysfunction (ED) in patients with established coronary artery disease (CAD) differs significantly by clinical presentation and atherosclerotic burden, investigators report in the (2006 July 19. Online before print).

Piero Montorsi, MD, of the University of Milan, Italy, and colleagues looked at the frequency of ED in 285 men with CAD according to clinical presentation—acute coronary syndrome (ACS) versus chronic coronary syndrome—and extent of vessel involvement.

The ED rate was low in patients with ACS and single-vessel disease and high in those with chronic coronary syndrome. Three times as many patients with chronic coronary syndrome had ED compared with those with ACS and single-vessel disease (65% vs 22%). The ED rate in control patients who had suspected CAD but normal arteries on angiography was similar to that in patients with ACS and single-vessel disease (24%). More than half (55%) of the patients with ACS and double- or triple-vessel disease had ED.

ED severity, but not prevalence, was found to be related to the extent of CAD. In addition, ED symptoms predated CAD symptoms in virtually all patients, with a mean interval of 3 years.

Although the study did not examine whether men with ED who had no other symptoms were at higher risk for future acute or chronic coronary syndrome compared with those without ED, Dr Montorsi said that all patients with ED should be evaluated for risk factors for cardiovascular events. “While waiting for further prospective, long-term studies, a strict medical surveillance program should be mandatory in patients with ED, multiple risk factors, and no clinical coronary artery disease,” he said, adding that research supports the concept that ED is the “sentinel of the heart.”

Drinkers Hide Cause of Injury from Their Doctors

LONDON—The injury rate among young people who drink excessively is high. However, alcohol abusers are reluctant to explain the circumstances surrounding their injury to their physician, new data suggest.

A survey commissioned by an association called the Drinkaware Trust found that roughly 50% of persons aged 18 to 25 years have been injured as a result of excessive drinking. What’s more, one third of them needed to see a doctor as a result, yet one fifth of them lied to the doctor about how their injury was sustained.

Injuries usually involved the back, neck, and ankle. Muscle aches from alcohol-related dehydration were also common.

Dementia Risk Can Be Predicted by Midlife

Lancet Neurol

STOCKHOLM—Investigators from the Karolinska Institute’s Aging Research Center claim that they have identified a group of risk factors in midlife that can pinpoint who is at highest risk for developing dementia later in life (. 2006;5:735-741).

Miia Kivipelto, MD, and colleagues at the Aging Research Centre in Stockholm, Sweden, analyzed data from a population-based study of 1409 people who were assessed for signs of dementia at midlife when they were about 50 years old and again about 20 years later.

At baseline and at 20-year follow-up, the participants completed a questionnaire that focused on health behaviors, health status, and medical history, particularly cardiovascular and cerebrovascular disease. Cholesterol levels, blood pressure, and body mass index were also measured at both time points.

During the 2 decades of follow-up, 61 (4%) of the participants were diagnosed with dementia. Increased risk for dementia was associated with being ≥47 years of age at baseline; having <10 years of education; and the presence of hypertension, hypercholesterolemia, or obesity. Dr Kivipelto and colleagues pointed out that many of the factors that predict dementia are also established risk factors for heart disease and stroke.

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