Prevalence of Erectile Dysfunction in Malagasy Patients With Diabetes Mellitus and Its Associations With Atherosclerotic Cardiovascular Diseases: A Cross-Sectional Study

Abstract

Objectives: Our study aims to determine the prevalence of erectile dysfunction (ED) and its associations with atherosclerotic cardiovascular disease (ASCVD) in Malagasy patients with diabetes mellitus (DM). Methods: This cross-sectional study was conducted over a period of 3 years at the Soavinandriana Hospital Center. Erectile function was assessed using the International Index of Erectile Function 5-item version (IIEF-5) questionnaire, with a score of less than 22 indicating ED. The presence of ASCVD was confirmed in cases where carotid atherosclerosis (CAS), lower limb arteriopathy (LLA), coronary heart disease (CHD) and/or ischaemic stroke were present. Results: The study population included 305 patients diagnosed with diabetes mellitus (DM). The prevalence of erectile dysfunction (ED) was 73.4%. According to the bivariate analysis, the risk factors for ED were age ≥ 55 years (odds ratio [OR] 12.0 (6.34–23.4)), hypertension (OR 6.02 (3.27–11.3)), physical inactivity (OR 8.86 (4.85–16.6)), smoking (OR 2.53 (1.32–5.09)), dyslipidemia (OR 4.11 (2.33–7.32)), type 2 DM (OR 8.80 (1.53–91.0)) and diabetes duration ≥ 10 years (OR 2.24 (1.11–4.87)), renin-angiotensin-aldosterone system blockers (OR 6.27 (3.43–11.6)), calcium-channel blockers (OR 3.01 (1.69–5.48)), diuretics (OR 2.14 (1.06–4.66)) and beta-blockers (OR 4.55 (1.85–13.5)). After adjusting for age, hypertension, physical inactivity, smoking and dyslipidemia, ED was significantly associated with ASCVD (OR 1.88 (1.01–3.69)), and CAS (OR 1.89 (1.03–3.22)). Adjusting for age, type and duration of DM, ED was found to be significantly associated with ASCVD (OR 1.91 (1.01–3.58)) and CAS (OR 2.31 (1.11–4.85)). However, there was no statistically significant association between ED, LLA, CHD and ischaemic stroke. Conclusion: ED was very common and may be a predictor of ASCVD in patients with DM, particularly CAS. Consequently, the presence of ED should prompt the search for ASCVD, and vice versa.