Association of Erectile Dysfunction With Cardiovascular Risk Factors and Increasing Existing Vascular Disease in Male Chinese Type 2 Diabetic Patients

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Abstract
Erectile dysfunction (ED) is a prevalent health problem and impacts considerably on the quality of life of middle-aged men (1). Previous studies have reported an association between ED, vascular disease (2,3), and cardiovascular risk factors (2–5), with ED being reported as both a symptom and marker of vascular disease progression (6,7). In Hong Kong, there is a high prevalence of diabetes and other risk factors, with 22.6% of older males (65–74 years) having diabetes, 37.2% having dyslipidemia, and 51.7% having hypertension (8). The Massachusetts Male Aging Study emphasized the close relationship between diabetes and ED, which was three times more prevalent in diabetic subjects than their nondiabetic counterparts (28 vs. 10%) (2). The high prevalence of diabetes and other risk factors may therefore have a significant impact on the prevalence of ED in Hong Kong. Patients were diagnosed as having type 2 diabetes using World Health Organization criteria (9) and underwent structured assessments using the EuroDiab Protocol (10). They were seen in a teaching hospital and tertiary referral center, but the government-funded health care system is such that many patients use the facility as their only source of subsidised medical care. Therefore, the study represents patients of low- and middle-income socioeconomic status. All patients gave written, informed consent. Assessments for micro- and macrovascular disease, including retinopathy, peripheral vascular disease, and middle cerebral artery (MCA) stenosis …