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Pauker-Sharon Y, Arbel Y, Finkelstein A, Halkin A, Herz I, Banai S, Justo D. Cardiovascular risk factors in men with ischemic heart disease and erectile dysfunction. Urology 2013; 82:377-80. [PMID: 23769116 DOI: 10.1016/j.urology.2013.03.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/02/2013] [Accepted: 03/07/2013] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To study the prevalence of cardiovascular risk factors in men with ischemic heart disease (IHD) and erectile dysfunction (ED). METHODS We studied cardiovascular risk factors in men with IHD and ED, who undergo coronary angiography. All men filled the Sexual Health Inventory for Males questionnaire (SHIM). SHIM questionnaire scores between 17 and 21 represented mild ED. SHIM questionnaire scores of 16 or lower represented significant ED. Cardiovascular risk factors included the following: age, diabetes mellitus, hypertension, smoking, hyperlipidemia, left ventricular ejection fraction ≤30%, and 3-vessel disease. Binary regression analysis was used to study which cardiovascular risk factors were independently associated with ED. RESULTS The study included 171 men. Mean age was 64.2 ± 12.6 years. Overall, 61 men (35.7%) had mild ED and 80 men (46.8%) had significant ED. More than half of men (n = 101; 59.1%) had 3 or more cardiovascular risk factors. Age was the only cardiovascular risk factor independently associated with significant ED (odds ratio 1.154; 95% confidence interval 1.081-1.232; P <.0001). No cardiovascular risk factors were independently associated with mild ED. CONCLUSION ED and its cardiovascular risk factors are highly prevalent in men with IHD. However, only age is independently associated with significant ED in this population.
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Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen RC, Sadovsky R, Seftel AD, Vlachopoulos C, Wu FC. Diagnosis and Treatment of Erectile Dysfunction for Reduction of Cardiovascular Risk. J Urol 2013; 189:2031-8. [DOI: 10.1016/j.juro.2012.12.107] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2012] [Indexed: 01/10/2023]
Affiliation(s)
- Ajay Nehra
- Rush University Medical Center, Chicago, Illinois
| | - Graham Jackson
- Guys and St. Thomas Hospitals London, London, United Kingdom
| | - Martin Miner
- Family Medicine and Urology, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Kevin L. Billups
- University of Minnesota, Minneapolis, Minnesota
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Arthur L. Burnett
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Jacques Buvat
- Centre d'Etude et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique, Lille, France
| | | | - Glenn R. Cunningham
- Baylor College of Medicine and St. Luke's Episcopal Hospital, Houston, Texas
| | | | - Andre T. Guay
- Center for Sexual Function/Endocrinology, Lahey Clinic Medical Center, Peabody, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Geoff Hackett
- Good Hope Hospital, Birmingham and Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Robert A. Kloner
- Good Samaritan Hospital and Department of Medicine, Keck School of Medicine at University of Southern California, Los Angeles, California
| | - John Kostis
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Piero Montorsi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Cardiology University of Milan, Milan, Italy
| | - Melinda Ramsey
- Complete Healthcare Communications, Inc., Chadds Ford, Pennsylvania
| | | | - Richard Sadovsky
- State University of New York-Downstate Medical Center, Brooklyn, New York
| | - Allen D. Seftel
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Cooper University Hospital, Camden, New Jersey
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Impaired flow-mediated vasodilatation in Asian Indians with erectile dysfunction. Asian J Androl 2013; 15:652-7. [PMID: 23708464 DOI: 10.1038/aja.2013.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/17/2013] [Accepted: 01/25/2013] [Indexed: 01/22/2023] Open
Abstract
Endothelial dysfunction is the postulated link between coronary artery disease (CAD) and erectile dysfunction (ED). Brachial artery flow-mediated vasodilatation (FMD) is a non-invasive surrogate marker for endothelial function assessment. Despite Asian Indians representing a considerable global CAD burden, data on FMD and ED in these patients are lacking. Of the 225 patients undergoing coronary angiography, 72% had ED (assessed using the International Index of Erectile Function (IIEF-5) questionnaire); ED was moderate to severe in 61% of the patients. ED patients had a higher incidence of severe and diffuse angiographic CAD, a greater number of coronary vessels involved and a lower mean brachial artery FMD (6.40%±4.60% vs. 9.10%±4.87%, P<0.001) compared to non-ED patients. A progressive reduction in FMD was noted with increasing severity of ED. Impaired FMD (≤5.5%) was twice as common in ED patients (52% vs. 24% without ED). Patients with impaired FMD had higher ED prevalence (85% vs. 62%) and lower mean IIEF-5 scores compared to those with normal FMD. Impaired FMD was a significant ED predictor independent of other risk factors (odds ratio, 2.33; 95% confidence interval: 0.59-9.23; P=0.03). An inverse correlation between FMD and ED severity was observed (r=-0.22; P=0.004). ED is common among Asian Indians with angiographically documented CAD. Patients with ED have impaired FMD independent of other risk factors, suggesting that endothelial dysfunction is the underlying pathophysiology. Urologists and cardiologists need to be aware of the association between ED, CAD and endothelial dysfunction.
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Anyfanti P, Pyrpasopoulou A, Triantafyllou A, Doumas M, Gavriilaki E, Triantafyllou G, Gkaliagkousi E, Chatzimichailidou S, Petidis K, Avagianou PA, Zamboulis C, Aslanidis S, Douma S. The impact of frequently encountered cardiovascular risk factors on sexual dysfunction in rheumatic disorders. Andrology 2013; 1:556-62. [DOI: 10.1111/j.2047-2927.2013.00094.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 03/28/2013] [Accepted: 04/02/2013] [Indexed: 01/23/2023]
Affiliation(s)
- P. Anyfanti
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - A. Pyrpasopoulou
- Department of Rheumatology - 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - A. Triantafyllou
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - M. Doumas
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - E. Gavriilaki
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - G. Triantafyllou
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - E. Gkaliagkousi
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - S. Chatzimichailidou
- Department of Rheumatology - 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - K. Petidis
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - P.-A. Avagianou
- Laboratory of Developmental Psychology and Psychopathology; Preschool Education Department; University of Thessaly; Thessaly; Greece
| | - C. Zamboulis
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - S. Aslanidis
- Department of Rheumatology - 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - S. Douma
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
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Abstract
Erectile dysfunction is common in the patient with cardiovascular disease. It is an important component of the quality of life and it also confers an independent risk for future cardiovascular events. The usual 3-year time period between the onset of erectile dysfunction symptoms and a cardiovascular event offers an opportunity for risk mitigation. Thus, sexual function should be incorporated into cardiovascular disease risk assessment for all men. A comprehensive approach to cardiovascular risk reduction (comprising of both lifestyle changes and pharmacological treatment) improves overall vascular health, including sexual function. Proper sexual counselling improves the quality of life and increases adherence to medication. This review explores the critical connection between erectile dysfunction and cardiovascular disease and evaluates how this relationship may influence clinical practice. Algorithms for the management of patient with erectile dysfunction according to the risk for sexual activity and future cardiovascular events are proposed.
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Affiliation(s)
- Charalambos Vlachopoulos
- 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Profiti Elia 24, Athens 14575, Greece.
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56
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Park NC, Kim TN, Park HJ. Treatment Strategy for Non-Responders to PDE5 Inhibitors. World J Mens Health 2013; 31:31-5. [PMID: 23658863 PMCID: PMC3640150 DOI: 10.5534/wjmh.2013.31.1.31] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/04/2013] [Indexed: 12/04/2022] Open
Abstract
Currently, phosphodiesterase type 5 (PDE5) inhibitors are the initial treatment option for erectile dysfunction. The reported efficacy of PDE5 inhibitors is about 70%, although it is significantly lower in difficult-to-treat subpopulations. Treatment failures might be due to the severity of the underlying pathophysiology, improper use of medication, unrealistic patient expectations, difficult relationship dynamics, severe performance anxiety, and other psychological problems. Physicians must address these issues to identify true treatment failures attributable to the drugs. This article discusses factors that might affect the response to PDE5 inhibitors and develops a strategy to maximize the overall efficacy of PDE5 inhibitors in initial non-responders to PDE5 inhibitors.
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Affiliation(s)
- Nam Cheol Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea. ; Medical Rresearch Iinstitute, Pusan National University Hospital, Busan, Korea
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Kumar J, Bhatia T, Kapoor A, Ranjan P, Srivastava A, Sinha A, Kumar S, Garg N, Tewari S, Kapoor R, Goel PK. Erectile dysfunction precedes and is associated with severity of coronary artery disease among Asian Indians. J Sex Med 2013; 10:1372-9. [PMID: 23347017 DOI: 10.1111/jsm.12041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) and coronary artery disease (CAD) often share common risk factors, and there is growing evidence that ED might serve as a clinical marker for cardiovascular disease. Despite rising trends of CAD in Asian Indians, limited data are available on the prevalence of ED and its correlation with CAD severity in such patients. AIM To study the prevalence of ED in Asian Indian patients undergoing coronary angiography and to assess if the severity of ED correlates with angiographic severity of CAD. METHODS In all patients undergoing coronary angiography, ED was assessed using the International Index of Erectile Function-5 questionnaire. MAIN OUTCOME MEASURES AND RESULTS Among 175 male patients, ED was present in 70%; patients with ED had a higher incidence of multivessel CAD (80% vs. 36%, P 0.001), diffuse CAD (81% vs. 34%, P 0.001), and higher number of mean coronary vessels involved compared with those without ED. Those with severe ED had higher prevalence of multivessel CAD and higher number of mean coronary vessels involved compared with those with milder grades of ED. Onset of symptoms of ED preceded symptoms of CAD by a mean of 24.6 months in 84% of patients. The presence of severe ED was associated with a 21-fold higher risk of having triple-vessel disease (odds ratio [OR] 21.94, 95% confidence interval [CI] 3.41-141.09, P = 0.001) and an 18-fold higher risk of having diffuse angiographic CAD (OR 17.91, 95% CI 3.11-111.09, P = 0.001). CONCLUSION Asian Indians with angiographic CAD frequently have ED; symptoms of ED precede that of CAD in most patients. Incidence of multivessel and diffuse CAD is significantly more common in patients with ED. It is important for physicians to be aware of the close relationship between the two conditions so that patients with ED can have optimal risk stratification for concomitant CAD whenever required.
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Affiliation(s)
- Jatinder Kumar
- Department of Urology and Renal Transplantation, Sanjay Gandhi PGIMS, Lucknow, India
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58
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Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes 2013; 6:99-109. [PMID: 23300267 DOI: 10.1161/circoutcomes.112.966903] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) carries an independent risk for cardiovascular (CV) events. We conducted a meta-analysis of all longitudinal studies for determining the ability of ED to predict risk of clinical events and to dissect factors influencing this ability. METHODS AND RESULTS We conducted a comprehensive search of electronic databases through July 2012. Longitudinal studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) were included. Of the 14 studies included (92 757 participants; mean follow-up, 6.1 years; 16 articles), 13 (14 articles) reported results on total CV events (91 831 individuals), 4 on CV mortality (34 761 individuals), 4 on myocardial infarction (35 523 individuals), 6 on cerebrovascular events (27 689 individuals), and 5 on all-cause mortality (17 869 individuals). The pooled RRs for the above-mentioned end points were 1.44 (95% CI, 1.27-1.63), 1.19 (95% CI, 0.97-1.46), 1.62 (95% CI, 1.34-1.96), 1.39 (95% CI, 1.23-1.57), and 1.25 (95% CI, 1.12-1.39), respectively, for men with versus without ED. The RR was higher in intermediate- compared with high- or low-CV-risk populations and with younger age. The RR for studies that diagnosed ED with the use of a questionnaire compared with a single question was higher (RR, 1.61; 95% CI, 1.38-1.86 versus RR, 1.27; 95% CI, 1.18-1.37, respectively; P=0.006). CONCLUSIONS ED is associated with increased risk of CV events and all-cause mortality. RR is higher at younger ages, in intermediate-risk groups, and when a questionnaire is used instead of a single question.
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Affiliation(s)
- Charalambos V Vlachopoulos
- Cardiovascular Diseases and Sexual Health Unit, First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
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59
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Huang CC, Chan WL, Chen YC, Chen TJ, Chung CM, Huang PH, Lin SJ, Chen JW, Leu HB. Herpes simplex virus infection and erectile dysfunction: a nationwide population-based study. Andrology 2012; 1:240-4. [DOI: 10.1111/j.2047-2927.2012.00037.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 09/08/2012] [Accepted: 10/08/2012] [Indexed: 12/13/2022]
Affiliation(s)
| | | | | | | | - C.-M. Chung
- Institute of Biomedical Sciences; Academia Sinica; Taipei; Taiwan
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60
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Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Ganz P, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FCW. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2012. [PMID: 22862865 DOI: 10.1016/j.mayocp] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up. The second objective focused on reevaluation and modification of previous recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD. The Panel's recommendations build on those developed during the first and second Princeton Consensus Conferences, first emphasizing the use of exercise ability and stress testing to ensure that each man's cardiovascular health is consistent with the physical demands of sexual activity before prescribing treatment for ED, and second highlighting the link between ED and CVD, which may be asymptomatic and may benefit from cardiovascular risk reduction.
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Affiliation(s)
- Ajay Nehra
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
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61
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Maio MT, Hannan JL, Komolova M, Adams MA. Caloric Restriction Prevents Visceral Adipose Tissue Accumulation and Maintains Erectile Function in Aging Rats. J Sex Med 2012; 9:2273-83. [DOI: 10.1111/j.1743-6109.2012.02681.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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62
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Salonia A, Castagna G, Saccà A, Ferrari M, Capitanio U, Castiglione F, Rocchini L, Briganti A, Rigatti P, Montorsi F. Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function-Erectile Function domain. J Sex Med 2012; 9:2708-15. [PMID: 22897643 DOI: 10.1111/j.1743-6109.2012.02869.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) has emerged progressively as a sentinel marker of cardiovascular disease (CVD). The correlation between ED and the burden arising from multiple comorbid conditions has been incompletely analyzed. AIM Assess whether erectile function, defined with the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score, is associated with health-significant comorbidities scored with the Charlson comorbidity index (CCI). METHODS Clinical and hemodynamic variables of the last 140 consecutive patients who underwent penile color Doppler ultrasonography for new-onset ED were considered. Patients were assessed with a thorough medical and sexual history. Health-significant comorbidities were scored with the CCI. MAIN OUTCOME MEASURE Descriptive statistics and either linear or logistic regression models tested the association among IIEF-EF, hemodynamic parameters, and CCI, which was included in the model both as continuous and categorized variable (0 vs. ≥1). RESULTS Complete data were available for 138 patients (98.6%) (mean age 46.6 years [standard deviation 13.0]; range 21-75 years). CCI was 0, 1, and ≥2 in 94 (68.1%), 23 (16.7%), and 21 (15.25%) patients, respectively. Of all, 35 patients (79.5%) did not have a CVD comorbidity. Mean IIEF-EF was 13.7 (9.3). ED severity was no ED, mild, mild to moderate, moderate, and severe in 12 (9.1%), 28 (20.2%), 12 (9.1%), 23 (16.2%), and 63 (45.5%) patients, respectively. At multivariable linear regression analysis, CCI significantly worsened with increased age (β=0.33; P=0.001) and decreased IIEF-EF values (β=-0.25; P=0.01). At logistic regression analysis, age (odds ratio [OR]: 1.05; P=0.004) and IIEF-EF (OR: 0.95; P=0.04) emerged as significant predictors of categorized CCI. CONCLUSIONS Severity of ED, as objectively interpreted with IIEF-EF, accounts for a higher CCI, which may be considered a reliable proxy of a lower general male health status regardless of the etiology of ED.
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Affiliation(s)
- Andrea Salonia
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
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63
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Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Ganz P, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FCW. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2012; 87:766-78. [PMID: 22862865 PMCID: PMC3498391 DOI: 10.1016/j.mayocp.2012.06.015] [Citation(s) in RCA: 268] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 06/11/2012] [Accepted: 06/11/2012] [Indexed: 02/07/2023]
Abstract
The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up. The second objective focused on reevaluation and modification of previous recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD. The Panel's recommendations build on those developed during the first and second Princeton Consensus Conferences, first emphasizing the use of exercise ability and stress testing to ensure that each man's cardiovascular health is consistent with the physical demands of sexual activity before prescribing treatment for ED, and second highlighting the link between ED and CVD, which may be asymptomatic and may benefit from cardiovascular risk reduction.
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Key Words
- abi, ankle-brachial index
- accf, american college of cardiology foundation
- aha, american heart association
- bmi, body mass index
- bp, blood pressure
- cacs, coronary artery calcium scoring
- cad, coronary artery disease
- ccta, coronary computed tomographic angiography
- cimt, carotid intima-media thickness
- cvd, cardiovascular disease
- ed, erectile dysfunction
- est, exercise stress testing
- frs, framingham risk score
- hdl, high-density lipoprotein
- hscrp, high-sensitivity c-reactive protein
- loe, level of evidence
- mets, metabolic equivalents of the task
- mi, myocardial infarction
- nyha, new york heart association
- pad, peripheral artery disease
- pde5, phosphodiesterase type 5
- pwv, pulse wave velocity
- trt, testosterone replacement therapy
- tt, total testosterone
- wc, waist circumference
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Affiliation(s)
- Ajay Nehra
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
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Vlachopoulos C, Terentes-Printzios D, Ioakeimidis N, Rokkas K, Samentzas A, Aggelis A, Kardara D, Stefanadis C. Beneficial Effect of Vardenafil on Aortic Stiffness and Wave Reflections. J Clin Pharmacol 2012; 52:1215-1221. [DOI: 10.1177/0091270011413586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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65
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Pharmaco-induced erections for penile color-duplex ultrasound: oral PDE5 inhibitors or intracavernosal injection? Int J Impot Res 2012; 24:191-5. [DOI: 10.1038/ijir.2012.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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66
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Alhathal N, Carrier S. Routine cardiac assessment is not necessary for all patients with erectile dysfunction. Can Urol Assoc J 2011; 5:349-51. [PMID: 22031617 DOI: 10.5489/cuaj.11218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Naif Alhathal
- Division of Urology, Department of Surgery, McGill University, Montreal, QC
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67
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Oral Tadalafil Administration Plus Low Dose Vasodilator Injection: A Novel Approach to Erection Induction for Penile Color Duplex Ultrasound. J Urol 2011; 186:228-32. [PMID: 21575959 DOI: 10.1016/j.juro.2011.02.2691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Indexed: 11/20/2022]
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68
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Ioakeimidis N, Vlachopoulos C, Rokkas K, Aggelis A, Terentes-Printzios D, Samentzas A, Alexopoulos N, Stefanadis C. Relationship of Asymmetric Dimethylarginine With Penile Doppler Ultrasound Parameters in Men with Vasculogenic Erectile Dysfunction. Eur Urol 2011; 59:948-55. [DOI: 10.1016/j.eururo.2011.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
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70
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Chou KT, Huang CC, Chen YM, Perng DW, Chao HS, Chan WL, Leu HB. Asthma and risk of erectile dysfunction--a nationwide population-based study. J Sex Med 2011; 8:1754-60. [PMID: 21426497 DOI: 10.1111/j.1743-6109.2011.02242.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The increased prevalence of erectile dysfunction (ED) has been reported in patients with chronic obstructive pulmonary disease, and sustained systemic inflammation seems to play a central role in this linkage. Asthma is also a chronic inflammatory airway disorder, eliciting a low-grade systemic inflammation; however, the influence of asthma on ED has not been investigated. AIM Our study strived to explore the relationship of asthma and the subsequent development of ED using a nationwide, population-based database. METHODS From 2000 to 2007, we identified newly diagnosed asthma cases involving male patients 18-55 years old. A control cohort without asthma, which was matched for age and comorbidities, was selected for comparison. MAIN OUTCOME MEASURES The two cohorts were followed up, and we observed the occurrence of ED by registry of ED diagnosis in the database. RESULTS Of the 17,302 sampled patients (3,466 asthma patients vs. 13,836 control), 114 (0.66%) experienced ED during a mean follow-up period of 4.56 years, including 34 (0.98% of the asthma patients) from the asthma cohort and 80 (0.58%) from the control group. Subjects with asthma experienced a 1.909-fold (95% confidence interval [CI], 1.276-2.856; P=0.002) increase in incident ED, which was independent of age, the number of clinical visits for urologist, and other comorbidities. Kaplan-Meier analysis also revealed the tendency of asthma patients for ED development (log rank test, P=0.002). The risk of ED was higher in cases with more frequent clinical visits for asthma (asthma patients with clinical visits with >24 times/year vs. <12 times/year: hazard ratio [HR]: 4.154 [95% CI:1.392-12.396], P=0.011; clinical visits with 12-24 times/year vs. <12 times/year HR: 3.534 [95% CI:1.245-10.032], P=0.018). CONCLUSIONS Asthma may be an independent risk factor for ED, and risk of ED probably increases in accordance with asthma severity.
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Affiliation(s)
- Kun-Ta Chou
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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71
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Miner MM, Seftel AD. Erectile dysfunction and testosterone screening with prostate specific antigen screening at age 40: are these three gender specific determinants additive for overall men's heath and do they improve traditional non-gender specific determinants to lessen cardiovascular risk and all-cause mortality? Int J Clin Pract 2010; 64:1754-62. [PMID: 21070526 DOI: 10.1111/j.1742-1241.2010.02521.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS Assess support for a recommendation to add screening for both erectile dysfunction (ED) and hypogonadism to the initial medical evaluation of young-to-middle aged (≥ 40 years of age) men in light of recent guidelines suggesting prostate-specific antigen screening occur at that age. METHODS A search of literature published from 1998 to 2009 was performed. Search terms included: ED combined with coronary artery disease (CAD), metabolic syndrome and hypogonadism, hypogonadism and ED, hypogonadism, ED and mortality. Articles were evaluated according to the Center of Evidence-Based Medicine. RESULTS Both retrospective and prospective evaluations have demonstrated a strong relationship between ED, established cardiovascular risk factors, CAD and the potential occurrence of cardiovascular events. Low testosterone levels are associated with ED. Low serum total testosterone is an independent risk factor for both metabolic syndrome and type 2 diabetes and all-cause mortality. CONCLUSION Traditionally, ED and testosterone levels have been considered mainly, if not exclusively, in the context of sexual health. The results briefly summarised herein and other recent reviews suggest that ED and hypogonadism are signals of future all-cause mortality and overall health status and thus move these evaluations into the broader arena of public health. Screening for ED and hypogonadism provide 'gender-specific determinants' to assess general metabolic and cardiovascular health risks in men. It is the opinion of the authors that this screening be performed in addition to the well-established non-gender-specific screening tests of lipids, blood pressure, obesity and serum glucose.
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Affiliation(s)
- M M Miner
- The Miriam Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
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72
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Chang ST, Chu CM, Hsiao JF, Chung CM, Shee JJ, Chen CS, Hsu JT. Coronary Phenotypes in Patients with Erectile Dysfunction and Silent Ischemic Heart Disease: A Pilot Study. J Sex Med 2010; 7:2798-804. [DOI: 10.1111/j.1743-6109.2010.01853.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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73
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Soner BC, Murat N, Demir O, Guven H, Esen A, Gidener S. Evaluation of vascular smooth muscle and corpus cavernosum on hypercholesterolemia. Is resveratrol promising on erectile dysfunction? Int J Impot Res 2010; 22:227-33. [PMID: 20596084 DOI: 10.1038/ijir.2010.8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The aim of this study is to evaluate the effects of hypercholesterolemia in thoracic aorta (TA), mesenteric artery (MA), renal artery (RA), and corpus cavernosum (CC) isolated from cholesterol-fed rabbits. For determination of the maximum detrimental effect, vasorelaxation and vasoconstriction results of arteries and CC have been compared. Animals were fed with a diet that contained 2% w/w cholesterol and 2% w/w high cholesterol plus resveratrol (4 mg kg(-1) per day) for 6-week duration. Total cholesterol levels in the plasma were measured. Vascular and endothelial functions in RA, TA, MA, and CC were assessed by isolated tissue bath with cumulative doses of acetylcholine and sodium nitroprusside. The statistical significance of differences of groups was analyzed by means of one-way ANOVA or Student's t-test. P-values <0.05 were considered significant. There have been no significant changes on plasma total cholesterol levels between cholesterol and cholesterol + resveratrol-treated groups. Vasorelaxation responses to acetylcholine in resveratrol-treated group showed significant changes when compared with hypercholesterolemic group. No statistically significant differences were seen between non-receptor-mediated vasorelaxation responses between the three groups. Resveratrol might be an effective treatment in the prevention of atherosclerotic changes in arteries and CC. The initial effects of hypercholesterolemia on erectile dysfunction and endothelial dysfunction may be precluded with resveratrol. This protective effect may also ensure the prevention of coronary arterial diseases and renovascular diseases in hypercholesterolemic patients.
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Affiliation(s)
- B C Soner
- Department of Pharmacology, Medical Faculty, Dokuz Eylul University, Izmir, Turkey
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74
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75
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Jackson G, Boon N, Eardley I, Kirby M, Dean J, Hackett G, Montorsi P, Montorsi F, Vlachopoulos C, Kloner R, Sharlip I, Miner M. Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract 2010; 64:848-57. [PMID: 20584218 DOI: 10.1111/j.1742-1241.2010.02410.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
* A significant proportion of men with erectile dysfunction (ED) exhibit early signs of coronary artery disease (CAD), and this group may develop more severe CAD than men without ED (Level 1, Grade A). * The time interval among the onset of ED symptoms and the occurrence of CAD symptoms and cardiovascular events is estimated at 2-3 years and 3-5 years respectively; this interval allows for risk factor reduction (Level 2, Grade B). * ED is associated with increased all-cause mortality primarily due to increased cardiovascular mortality (Level 1, Grade A). * All men with ED should undergo a thorough medical assessment, including testosterone, fasting lipids, fasting glucose and blood pressure measurement. Following assessment, patients should be stratified according to the risk of future cardiovascular events. Those at high risk of cardiovascular disease should be evaluated by stress testing with selective use of computed tomography (CT) or coronary angiography (Level 1, Grade A). * Improvement in cardiovascular risk factors such as weight loss and increased physical activity has been reported to improve erectile function (Level 1, Grade A). * In men with ED, hypertension, diabetes and hyperlipidaemia should be treated aggressively, bearing in mind the potential side effects (Level 1, Grade A). * Management of ED is secondary to stabilising cardiovascular function, and controlling cardiovascular symptoms and exercise tolerance should be established prior to initiation of ED therapy (Level 1, Grade A). * Clinical evidence supports the use of phosphodiesterase 5 (PDE5) inhibitors as first-line therapy in men with CAD and comorbid ED and those with diabetes and ED (Level 1, Grade A). * Total testosterone and selectively free testosterone levels should be measured in all men with ED in accordance with contemporary guidelines and particularly in those who fail to respond to PDE5 inhibitors or have a chronic illness associated with low testosterone (Level 1, Grade A). * Testosterone replacement therapy may lead to symptomatic improvement (improved wellbeing) and enhance the effectiveness of PDE5 inhibitors (Level 1, Grade A). * Review of cardiovascular status and response to ED therapy should be performed at regular intervals (Level 1, Grade A).
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Affiliation(s)
- G Jackson
- Cardiology, London Bridge Hospital, London, UK.
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76
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Gratzke C, Angulo J, Chitaley K, Dai YT, Kim NN, Paick JS, Simonsen U, Uckert S, Wespes E, Andersson KE, Lue TF, Stief CG. Anatomy, physiology, and pathophysiology of erectile dysfunction. J Sex Med 2010; 7:445-75. [PMID: 20092448 DOI: 10.1111/j.1743-6109.2009.01624.x] [Citation(s) in RCA: 231] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Significant scientific advances during the past 3 decades have deepened our understanding of the physiology and pathophysiology of penile erection. A critical evaluation of the current state of knowledge is essential to provide perspective for future research and development of new therapies. AIM To develop an evidence-based, state-of-the-art consensus report on the anatomy, physiology, and pathophysiology of erectile dysfunction (ED). METHODS Consensus process over a period of 16 months, representing the opinions of 12 experts from seven countries. MAIN OUTCOME MEASURE Expert opinion was based on the grading of scientific and evidence-based medical literature, internal committee discussion, public presentation, and debate. RESULTS ED occurs from multifaceted, complex mechanisms that can involve disruptions in neural, vascular, and hormonal signaling. Research on central neural regulation of penile erection is progressing rapidly with the identification of key neurotransmitters and the association of neural structures with both spinal and supraspinal pathways that regulate sexual function. In parallel to advances in cardiovascular physiology, the most extensive efforts in the physiology of penile erection have focused on elucidating mechanisms that regulate the functions of the endothelium and vascular smooth muscle of the corpus cavernosum. Major health concerns such as atherosclerosis, hyperlipidemia, hypertension, diabetes, and metabolic syndrome (MetS) have become well integrated into the investigation of ED. CONCLUSIONS Despite the efficacy of current therapies, they remain insufficient to address growing patient populations, such as those with diabetes and MetS. In addition, increasing awareness of the adverse side effects of commonly prescribed medications on sexual function provides a rationale for developing new treatment strategies that minimize the likelihood of causing sexual dysfunction. Many basic questions with regard to erectile function remain unanswered and further laboratory and clinical studies are necessary.
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Affiliation(s)
- Christian Gratzke
- Department of Urology, Ludwig-Maximilians-Universität, München, Germany
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77
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Jackson G, Montorsi P, Adams MA, Anis T, El-Sakka A, Miner M, Vlachopoulos C, Kim E. Cardiovascular Aspects of Sexual Medicine. J Sex Med 2010; 7:1608-26. [DOI: 10.1111/j.1743-6109.2010.01779.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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78
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Chang ST, Chu CM, Hsu JT, Hsiao JF, Chung CM, Ho C, Peng YS, Chen PY, Shee JJ. Independent Determinants of Coronary Artery Disease in Erectile Dysfunction Patients. J Sex Med 2010; 7:1478-87. [DOI: 10.1111/j.1743-6109.2009.01562.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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79
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Bouwman II, Van Der Heide WK, Van Der Meer K, Nijman R. Correlations between lower urinary tract symptoms, erectile dysfunction, and cardiovascular diseases: Are there differences between male populations from primary healthcare and urology clinics? A review of the current knowledge. Eur J Gen Pract 2009; 15:128-35. [DOI: 10.3109/13814780903329536] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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80
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Salem S, Abdi S, Mehrsai A, Saboury B, Saraji A, Shokohideh V, Pourmand G. Erectile Dysfunction Severity as a Risk Predictor for Coronary Artery Disease. J Sex Med 2009; 6:3425-32. [DOI: 10.1111/j.1743-6109.2009.01515.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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81
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Vlachopoulos C, Ioakeimidis N, Terentes-Printzios D, Rokkas K, Aznaouridis K, Baou K, Bratsas A, Fassoulakis C, Stefanadis C. Amino-Terminal Pro-C-Type Natriuretic Peptide is Associated with the Presence, Severity, and Duration of Vasculogenic Erectile Dysfunction. Eur Urol 2009; 56:552-8. [DOI: 10.1016/j.eururo.2008.11.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 11/12/2008] [Indexed: 01/31/2023]
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82
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Schwartz BG, Kloner RA. How to save a life during a clinic visit for erectile dysfunction by modifying cardiovascular risk factors. Int J Impot Res 2009; 21:327-35. [PMID: 19693019 DOI: 10.1038/ijir.2009.38] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Erectile dysfunction (ED) is an early marker for systemic atherosclerosis and is a predictor for coronary artery disease and cardiac events. The aim of this paper is to convey the importance of addressing cardiovascular risk factors in patients with ED and to inform urologists as well as other physicians who are not specialized in cardiology how to carry out a basic cardiovascular evaluation, including history, physical examination and objective data. We review the evidence and pathophysiology linking ED to cardiovascular disease, and then describe how to carry out a basic cardiovascular evaluation. We present data from the literature showing that appropriate use of lifestyle modifications and medical therapy has a positive effect on mortality, on numerous cardiovascular end points and on ED. Suggestions of when to refer the ED patient to an internist or cardiologist are provided. Identifying and treating cardiovascular risk factors may not only benefit the patient's ED, but it might also save the patient's life.
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Affiliation(s)
- B G Schwartz
- Heart Institute, Good Samaritan Hospital, Los Angeles, CA 90017-2395, USA
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83
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Meluzín J, Vasků A, Kincl V, Panovský R, Srámková T. Association of coronary artery disease, erectile dysfunction, and endothelial nitric oxide synthase polymorphisms. Heart Vessels 2009; 24:157-63. [PMID: 19466514 DOI: 10.1007/s00380-008-1097-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 07/30/2008] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to determine the relationship between erectile dysfunction (ED), coronary artery disease (CAD), and T(-786)C and intron 4 a/b endothelial nitric oxide synthase (eNOS) polymorphisms in 419 patients with suspected or known CAD referred for coronary angiography. The patients had a high prevalence of risk factors for both CAD and ED: hypercholesterolemia (64%), hypertension (74%), diabetes mellitus (25%), obesity (30%), and smoking (63%). Three hundred and twenty-one patients had significant coronary atherosclerosis (luminal diameter narrowing of 50% or more of at least 1 coronary artery), 41 had insignificant coronary stenoses, and 57 patients were found to have coronary arteries without the evidence of atherosclerosis. The prevalence of ED in these groups was 79%, 76%, and 67% (P = NS), respectively. As compared to patients without ED, those with ED exhibited significantly higher probability of having significant coronary atherosclerosis (69% vs 79%, P = 0.04), higher number of significant coronary stenoses (median, 1 vs 2, P = 0.004), and a higher prevalence of a triple-vessel disease (12% vs 25%, P = 0.004). We did not find any relationship between T(-786)C and intron 4 a/b polymorphisms and the manifestation of coronary atherosclerosis or the presence of ED. In conclusion, in patients with numerous cardiovascular risk factors referred for coronary angiography, there was a high prevalence of ED in patients with both the presence and the absence of coronary atherosclerosis. The coincidence of CAD and ED identified patients at increased risk of severe forms of CAD.
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Affiliation(s)
- Jaroslav Meluzín
- First Department of Internal Medicine/Cardioangiology, ICRC, St. Anna Hospital, Masaryk University, Pekarská 53, Brno 65691, Czech Republic.
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84
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Erektile Dysfunktion: Indikator für Endorganschädigung beim kardiovaskulären Patienten. ACTA ACUST UNITED AC 2009; 104:309-13. [DOI: 10.1007/s00063-009-1051-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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85
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Is ED Still Only Equal to ED? Eur Urol 2009; 55:794-7; discussion 797-800. [DOI: 10.1016/j.eururo.2008.08.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 08/26/2008] [Indexed: 11/23/2022]
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86
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Mulhall J, Teloken P, Barnas J. Vasculogenic Erectile Dysfunction Is a Predictor of Abnormal Stress Echocardiography. J Sex Med 2009; 6:820-5. [DOI: 10.1111/j.1743-6109.2008.01087.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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87
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Strategies to Improve Endothelial Function and its Clinical Relevance to Erectile Dysfunction. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.eursup.2008.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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89
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Neves D, Assunção M, Marques F, Andrade JP, Almeida H. Does regular consumption of green tea influence expression of vascular endothelial growth factor and its receptor in aged rat erectile tissue? Possible implications for vasculogenic erectile dysfunction progression. AGE (DORDRECHT, NETHERLANDS) 2008; 30:217-228. [PMID: 19424845 PMCID: PMC2585648 DOI: 10.1007/s11357-008-9051-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 02/29/2008] [Indexed: 05/27/2023]
Abstract
Erectile dysfunction (ED) is a highly prevalent disease affecting millions of men worldwide with a tendency for widespread increase. ED is now considered an early manifestation of atherosclerosis and, consequently, a precursor of systemic vascular disease. Atherosclerosis and ED share potentially modifiable risk factors, as smoking or high-fat food intake, but it is unclear how regular consumption of anti-oxidant rich drinks, which exhibit recognised anti-atherosclerotic features, affects ED progression. The objective of this study was to evaluate the modulating effects of chronic consumption of catechin-rich beverages on the vascular structure of the rat corpus cavernosum, and how this could contribute to delay or prevention of the onset of ED. Male Wistar rats aged 12 months were treated with green tea (GT) or a green tea extract solution (GTE) as the only liquid source for 6 months. Consumption of GT and GTE led to decreased plasma androgen levels without any significant change in plasma lipid levels. A reduction in corpus cavernosum intracellular storage of lipids, associated with decreased expression of vascular endothelial growth factor (VEGF) and its receptor VEGFR2 in endothelial cells, was observed. Taken together, these results suggest diminished atherosclerotic progression in cavernous tissue. However, functional studies will be necessary to elucidate if catechin-rich beverages are useful compounds in the prevention of deleterious vascular events associated with ED. It was also demonstrated that regular consumption of catechins reduces atherosclerotic progression and mortality due to cardiovascular disease. The results reported here suggest diminished atherosclerotic progression in cavernous tissue in aged rats following chronic ingestion of catechin-rich beverages.
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Affiliation(s)
- D Neves
- Laboratory for Molecular Cell Biology, Faculty of Medicine and IBMC, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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90
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Sexual dysfunction: the 'prima ballerina' of hypertension-related quality-of-life complications. J Hypertens 2008; 26:2074-84. [PMID: 18854743 DOI: 10.1097/hjh.0b013e32830dd0c6] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sexual dysfunction is currently considered a serious quality-of-life-related health problem, exerting a major impact on patients' and their sexual partners' life. Available data indicate that essential hypertension is a risk factor for sexual dysfunction, as male and female sexual dysfunction is more prevalent in hypertensive patients than normotensive individuals. Several mechanisms have been implicated in the pathogenesis of sexual dysfunction in hypertensive patients, and major determinants include severity and duration of hypertension, age, and antihypertensive therapy. Female sexual dysfunction, although more frequent than its male counterpart, remains largely under-recognized. Older antihypertensive drugs (diuretics, beta-blockers, centrally acting) exert negative results, whereas newer drugs have either neutral (calcium antagonists, angiotensin-converting enzyme inhibitors) or beneficial effects (angiotensin receptor blockers). Erectile dysfunction is related to ischemic heart disease and might be an 'early therapeutic window' of asymptomatic coronary artery disease. It seems of utmost importance for every physician treating hypertensive patients to become familiar with sexual dysfunction (through better education and specific seminars) for the proper management of these patients.
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91
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Agrawal V, Ellins E, Donald A, Minhas S, Halcox J, Ralph DJ. ORIGINAL RESEARCH—PEYRONIE'S DISEASE: Systemic Vascular Endothelial Dysfunction in Peyronie's Disease. J Sex Med 2008; 5:2688-93. [DOI: 10.1111/j.1743-6109.2008.00947.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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92
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Eardley I, Lee JC, Guay AT. Global experiences with vardenafil in men with erectile dysfunction and underlying conditions. Int J Clin Pract 2008; 62:1594-603. [PMID: 18822030 DOI: 10.1111/j.1742-1241.2008.01852.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Vardenafil has demonstrated efficacy for the pharmacological management of erectile dysfunction (ED). Accumulating evidence suggests that ED is frequently associated with underlying cardiovascular and metabolic conditions which are thought to be involved in the aetiology of ED. The present review aims to summarise and discuss the available evidence for the efficacy, safety and tolerability of vardenafil in patients with underlying conditions including diabetes, hypertension and dyslipidaemia. METHODS Relevant articles were identified through a PubMed search of clinical trials and postmarketing surveillance studies of vardenafil in patients with ED including those with diabetes, hypertension and dyslipidaemia. RESULTS Across all trials, vardenafil showed good efficacy for the treatment of ED in patients with diabetes, hypertension and dyslipidaemia. Vardenafil also showed a favourable safety and tolerability profile. The concomitant use of medication to treat hypertension or dyslipidaemia was not associated with an increase in adverse events following vardenafil treatment. CONCLUSIONS The prevalence of both diagnosed and undiagnosed underlying conditions is high among men with ED. The evidence presented in this review suggests that vardenafil is efficacious and well tolerated in patients with ED and diabetes, hypertension and/or dyslipidaemia and can be recommended as first-line treatment for ED in patients with these conditions.
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Affiliation(s)
- I Eardley
- Pyrah Department of Urology, St James's University Hospital, Leeds, UK.
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93
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Arterial function and intima-media thickness in hypertensive patients with erectile dysfunction. J Hypertens 2008; 26:1829-36. [DOI: 10.1097/hjh.0b013e3283050886] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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94
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Suetomi T, Kawai K, Hinotsu S, Joraku A, Oikawa T, Sekido N, Miyanaga N, Shimazui T, Akaza H. Negative Impact of Metabolic Syndrome on the Responsiveness to Sildenafil in Japanese Men. J Sex Med 2008; 5:1443-50. [DOI: 10.1111/j.1743-6109.2007.00747.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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95
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Assessment of endothelial function in the patient with erectile dysfunction: an opportunity for the urologist. Int J Impot Res 2008; 20:370-7. [DOI: 10.1038/ijir.2008.13] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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96
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Guirao Sánchez L, García-Giralda Ruiz L, Casas Aranda I, Alfaro González JV, Sánchez Pérez GA, Piñera Guirao A, Sandoval Martínez C. Disfunción eréctil: de marcador de salud a factor de riesgo cardiovascular independiente en atención primaria. Rev Int Androl 2008. [DOI: 10.1016/s1698-031x(08)72562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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97
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Comparison of findings on stress myocardial perfusion imaging in men with versus without erectile dysfunction and without prior heart disease. Am J Cardiol 2008; 101:502-5. [PMID: 18312766 DOI: 10.1016/j.amjcard.2007.09.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 09/17/2007] [Accepted: 09/21/2007] [Indexed: 01/16/2023]
Abstract
Erectile dysfunction (ED) has been associated with a future risk of myocardial infarction, yet the findings on stress testing in men with ED and without previous coronary artery disease are unknown. Stress myocardial perfusion single-photon emission computed tomographic imaging (MPI) allows detection of coronary artery disease and predicts cardiovascular prognosis. Our goal was to determine the association between ED and findings at stress MPI testing in men without previous coronary artery disease. Five hundred seventy-five men without previous coronary artery disease referred for stress MPI were prospectively screened for ED with the validated International Index of Erectile Function. ED was present in 46% of subjects, and ED was associated with more mild (summed stress score >or=4) and severe (summed stress score >8) coronary artery disease and with more composite high-risk stress MPI findings (summed stress score >8, left ventricular ejection fraction <40%, transient ischemic dilation). In patients referred for exercise, ED was associated with a lower Duke treadmill score. On multivariate analysis, ED was found to be an independent predictor of a summed stress score >or=4, a summed stress score >8, and composite high-risk MPI findings. In conclusion, in men without known coronary artery disease referred for stress MPI testing, ED is associated with adverse prognostic indicators at MPI testing including coronary artery disease and high-risk MPI findings.
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Vlachopoulos C, Rokkas K, Ioakeimidis N, Stefanadis C. Inflammation, Metabolic Syndrome, Erectile Dysfunction, and Coronary Artery Disease: Common Links. Eur Urol 2007; 52:1590-600. [PMID: 17707576 DOI: 10.1016/j.eururo.2007.08.004] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2007] [Accepted: 08/02/2007] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Erectile dysfunction (ED) may be the early clinical manifestation of a generalized vascular disease and carries an independent risk for cardiovascular events. Low-grade subclinical inflammation affects endothelial function and is involved in all stages of the atherosclerotic process. This review identifies potential pathophysiologic links among low-grade inflammation, ED, metabolic syndrome, and coronary artery disease (CAD) and presents the clinical implications in terms of ED diagnosis, assessment of patient risk, and therapy. METHODS A comprehensive evaluation was performed for available published data in full-length papers that were identified in MedLine up to July 2007. RESULTS Studies support an association between metabolic syndrome, ED, and increased inflammatory state. Increased circulating levels of inflammatory and endothelial-prothrombotic compounds are related to the presence and severity of ED. Specific inflammatory biomarkers and their combination appear to have the potential to aid ED diagnosis or exclusion. ED and CAD may confer a similar unfavorable impact on the inflammatory and prothrombotic state, whereas ED adds an incremental activation on top of CAD; these findings have important implications for cardiovascular risk. Lifestyle and risk factor modification, as well as pharmacologic therapy, are associated with anti-inflammatory effects. CONCLUSIONS Low-grade systemic inflammation could be an important element of the association between metabolic syndrome, ED, and CAD. Its individualized assessment may be a valuable tool for ED diagnosis, risk assessment, and rationalized therapeutic approach especially in patients with ED who have metabolic syndrome and carry an intermediate risk for future cardiovascular events.
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Affiliation(s)
- Charalambos Vlachopoulos
- Cardiovascular Diseases and Sexual Health Unit, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
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Anand RG, Ventura HO, Mehra MR. Is Heart Failure More Prevalent in Patients With Peripheral Arterial Disease? A Meta-Analysis. ACTA ACUST UNITED AC 2007; 13:319-22. [DOI: 10.1111/j.1527-5299.2007.07344.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Kaya C, Ergelen M, Ilktac A, Karaman MI. Impaired Elasticity of Aorta in Patients with Erectile Dysfunction. Urology 2007; 70:558-62. [PMID: 17688916 DOI: 10.1016/j.urology.2007.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 03/12/2007] [Accepted: 04/18/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The close relationship between the elasticity of the aorta and cardiovascular disease has aroused the interest of investigators in performing studies related to aortic stiffness parameters. We investigated the aortic stiffness parameters in patients with erectile dysfunction (ED) without known cardiovascular disease and diabetes were investigated. METHODS The study included 40 men with ED (aged 56 +/- 8 years) according to the Doppler penile ultrasound findings and the five-item version of the International Index of Erectile Function score (group 1) and 25 healthy men (aged 53 +/- 5 years; group 2) underwent fasting serum glucose and lipid level determination. Echocardiography (using a 3.75-MHz transducer) and exercise treadmill test were performed. The diameter change, pulse pressure, aortic strain index, and distensibility index as aortic stiffness parameters were investigated in patients with ED and compared with those of healthy subjects. RESULTS The average International Index of Erectile Function-5 score of those with ED (group 1) and the control groups (group 2) was 11.2 and 23.2, respectively. Body mass index, age, fasting serum glucose, and lipid profile were not significantly different between the two groups. All patients had negative results on the exercise stress test; and the echocardiography parameters were similar. The percentage of aortic strain (group 1, 4.64 +/- 2.43 versus group 2, 10.21 +/- 5.13, P = 0.021) and the value of the distensibility index (group 1, 0.21 +/- 0.15 versus group 2, 0.51 +/- 0.20 cm2/dyn/10(-3), P <0.001 were significantly lower in the ED group than were those of the control group. CONCLUSIONS The results of our study have shown that the aortic strain index and distensibility index are impaired in patients with ED. This suggests that ED is a generalized vessel disease rather than a disorder peculiar to the penile arteries.
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Affiliation(s)
- Cevdet Kaya
- Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
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