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Eren H, Omar MB, Kaya Ü, Özbey EG, Öcal L. Epicardial fat tissue can predict subclinical left ventricular dysfunction in patients with erectile dysfunction. Aging Male 2021; 24:42-49. [PMID: 34193020 DOI: 10.1080/13685538.2021.1945572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is an early form of atherosclerosis and subclinical myocardial dysfunction. Epicardial fat tissue (EFT) is associated with impaired left ventricular (LV) function, even in the absence of cardiovascular disease. The aim of this study was to investigate the association between EFT and LV systolic function in patients with erectile ED by speckle tracking echocardiography (2D-STE) method. METHODS A total of 129 consecutive patients with ED were compared with 145 age- and sex-matched control subjects. ED was evaluated using the International Index of Erectile Function questionnaire. Thickness of EFT was measured by TTE. Global LV longitudinal strain (LV-GLS) and global LV circumferential strain (LV-GCS) were measured by 2D-STE method. RESULTS The EFT thickness was significantly higher in the patients with ED (p <.01). LV-GLS and LV-GCS were revealed to be more deterioration in the ED group compared to controls (-18.2 ± 2.7 vs. (-21.1 ± 3.9, p<.001; -19.5 ± 4.1 vs. -21.9 ± 3.9, p<.001, respectively). It has been shown that EFT thickness is an independent predictor of LV dysfunction. CONCLUSIONS These results indicate that EFT thickness is associated with subclinical LV systolic dysfunction in patients with ED.
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Affiliation(s)
- Hayati Eren
- Department of Cardiology, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Muhammed Bahadır Omar
- Department of Cardiology, Fatih Sultan Mehmet Research and Training Hospital, İstanbul, Turkey
| | - Ülker Kaya
- Department of Cardiology, Elbistan State Hospital, Kahramanmaraş, Turkey
| | | | - Lütfi Öcal
- Department of Cardiology, İstanbul Kartal Koşuyolu Research and Training Hospital, İstanbul, Turkey
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Roushias S, Ossei-Gerning N. Sexual function and cardiovascular disease: what the general cardiologist needs to know. Heart 2018; 105:160-168. [PMID: 30185458 DOI: 10.1136/heartjnl-2016-310762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Stella Roushias
- Urology Department, Cardiff and Vale University Health Board, Cardiff, UK
| | - Nicholas Ossei-Gerning
- Cardiology Department, University Hospital of Wales, Cardiff, UK.,University of Wales Trinity Saint David, Swansea, Wales
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Colson M, Cuzin B, Faix A, Grellet L, Huyghes E. Current epidemiology of erectile dysfunction, an update. SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Colson M, Cuzin B, Faix A, Grellet L, Huyghes E. Cœur et sexe, quoi de neuf ? SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Prevalence and factors associated with erectile dysfunction in patients with chronic kidney disease on conservative treatment. Int J Impot Res 2017; 29:219-224. [DOI: 10.1038/ijir.2017.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 02/05/2017] [Accepted: 03/02/2017] [Indexed: 12/19/2022]
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7
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Zehir R, Karabay CY, Kocabay G, Erdem MR, Balaban M, Kirma C. Role of 2D Strain in the Early Identification of Cardiac Dysfunction and in the Risk Stratification of Arteriogenic Erectile Dysfunction Patients. J Sex Med 2016; 13:1227-32. [DOI: 10.1016/j.jsxm.2016.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/09/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
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Raheem OA, Su JJ, Wilson JR, Hsieh TC. The Association of Erectile Dysfunction and Cardiovascular Disease: A Systematic Critical Review. Am J Mens Health 2016; 11:552-563. [PMID: 26846406 DOI: 10.1177/1557988316630305] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Despite strong association between erectile dysfunction (ED) and cardiovascular disease (CVD), there is a paucity of clear clinical guidelines detailing when and how to evaluate for ED in patients with known CVD, or vice versa. This systematic review discuss the role of cardiologists and urologists in the characterization of risk and management of CVD in the setting of ED, as well as contrasting the current evaluation of CVD and ED from the standpoint of published consensus statements. A comprehensive literature review utilizing MEDLINE®, the Cochrane Library® Central Search, and the Web of Science was performed to identify all published peer-reviewed articles in the English language describing ED and CVD across various disciplines. There is strong consensus that men with ED should be considered at high risk of CVD. Available risk assessment tools should be used to stratify the coronary risk score in each patient. The 2012 Princeton III Consensus Conference expanded on existing cardiovascular recommendations, proposing an approach to the evaluation and management of cardiovascular risk in men with ED and no known CVD. This systematic review highlights the similarities and differences of the existing clinical guidelines and recommendations regarding assessment and management of ED and CVD, as well as the pathophysiological linkage between ED and CVD, which may permit physicians, including urologists, to perform opportunistic screening and initiate secondary prophylaxis with regard to cardiovascular risk factors, particularly in young, nondiabetic men with ED.
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Affiliation(s)
- Omer A Raheem
- 1 University of California, San Diego, Department of Urology, San Diego, CA, USA
| | - Jeannie J Su
- 2 Yale School of Medicine, Department of Urology, New Haven, CT, USA
| | - Joel R Wilson
- 3 University of California, San Diego, Department of Medicine, Division of Cardiovascular Medicine, San Diego, CA, USA
| | - Tung-Chin Hsieh
- 1 University of California, San Diego, Department of Urology, San Diego, CA, USA
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Jackson G. Prediction of Coronary Artery Disease by Erectile Function Status: Evidence-Based Data. Sex Med Rev 2015; 1:104-107. [PMID: 27784583 DOI: 10.1002/smrj.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The link between erectile dysfunction (ED) and cardiovascular disease (CVD) has been established as a result of individual studies and meta-analyses. ED predicts CVD, coronary disease, myocardial infarction, heart failure, and increased mortality. ED may occur on average 2-5 years before a CVD event and act as a marker for early asymptomatic vascular, and especially coronary artery, disease. Seventy percent of men with known CVD also have ED that identifies a further increased CVD event risk when compared with men with normal erections. Importantly, those at highest risk are men with ED aged 30-60 years and diabetics where CVD detection and prevention need the most focus. A question on ED should be incorporated in all CVD risk calculators, and when risk is identified, action to reduce risk should be aggressively initiated and monitored. Jackson G. Prediction of coronary artery disease by erectile function status: Evidence-based data. Sex Med Rev 2013;1:104-107.
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Papadopoulou E, Varouktsi A, Lazaridis A, Boutari C, Doumas M. Erectile dysfunction in chronic kidney disease: From pathophysiology to management. World J Nephrol 2015; 4:379-387. [PMID: 26167462 PMCID: PMC4491929 DOI: 10.5527/wjn.v4.i3.379] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 12/27/2014] [Accepted: 05/28/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) is encountered in millions of people worldwide, with continuously rising incidence during the past decades, affecting their quality of life despite the increase of life expectancy in these patients. Disturbance of sexual function is common among men with CKD, as both conditions share common pathophysiological causes, such as vascular or hormonal abnormalities and are both affected by similar coexisting comorbid conditions such as cardiovascular disease, hypertension and diabetes mellitus. The estimated prevalence of erectile dysfunction reaches 70% in end stage renal disease patients. Nevertheless, sexual dysfunction remains under-recognized and under-treated in a high proportion of these patients, a fact which should raise awareness among clinicians. A multifactorial approach in management and treatment is undoubtedly required in order to improve patients’ quality of life and cardiovascular outcomes.
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12
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Kaya E, Sikka SC, Gur S. A comprehensive review of metabolic syndrome affecting erectile dysfunction. J Sex Med 2015; 12:856-75. [PMID: 25675988 DOI: 10.1111/jsm.12828] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Metabolic syndrome (MetS) is the most important public health issue threatening the health of men and women all over the world. Its current prevalence (i.e., approximately 30%) is continuously increasing. MetS by itself is considered a risk factor for erectile dysfunction (ED). AIM To focus on the definition epidemiology, pathogenesis, and possible mechanistic links between MetS and ED in order to provide guidelines for treating such individuals. METHODS The search strategies yielded total records screened from PubMed. MAIN OUTCOME MEASURES Regardless of the definition, MetS consists of insulin resistance, hypertension, dyslipidemia, and obesity. MetS is not an end disease but is a disorder of energy utilization and storage. RESULTS The prevalence of ED in patients with MetS is almost twice than in those without MetS, and about 40% of patients with ED have MetS. An important mechanism linking MetS and ED is hypogonadism. CONCLUSIONS Recognizing through ED, underlying conditions such as hypogonadism, diabetes and MetS might be a useful motivation for men to improve their health-related choices. The clinical management of MetS can be done by therapeutic interventions that include lifestyle modifications, hormone replacement alone or in combination with phosphodiesterase 5 inhibitors, and other pharmacological treatments.
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Affiliation(s)
- Ecem Kaya
- Departments of Biochemistry and Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
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13
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Miner M, Nehra A, Jackson G, Bhasin S, Billups K, Burnett AL, Buvat J, Carson C, Cunningham G, Ganz P, Goldstein I, Guay A, Hackett G, Kloner RA, Kostis JB, LaFlamme KE, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel A, Shabsigh R, Vlachopoulos C, Wu F. All men with vasculogenic erectile dysfunction require a cardiovascular workup. Am J Med 2014; 127:174-82. [PMID: 24423973 DOI: 10.1016/j.amjmed.2013.10.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 11/18/2022]
Abstract
An association between erectile dysfunction and cardiovascular disease has long been recognized, and studies suggest that erectile dysfunction is an independent marker of cardiovascular disease risk. Therefore, assessment and management of erectile dysfunction may help identify and reduce the risk of future cardiovascular events, particularly in younger men. The initial erectile dysfunction evaluation should distinguish between predominantly vasculogenic erectile dysfunction and erectile dysfunction of other etiologies. For men believed to have predominantly vasculogenic erectile dysfunction, we recommend that initial cardiovascular risk stratification be based on the Framingham Risk Score. Management of men with erectile dysfunction who are at low risk for cardiovascular disease should focus on risk-factor control; men at high risk, including those with cardiovascular symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo noninvasive evaluation for subclinical atherosclerosis. A growing body of evidence supports the use of emerging prognostic markers to further understand cardiovascular risk in men with erectile dysfunction, but few markers have been prospectively evaluated in this population. In conclusion, we support cardiovascular risk stratification and risk-factor management in all men with vasculogenic erectile dysfunction.
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Affiliation(s)
- Martin Miner
- Departments of Family Medicine and Urology, Miriam Hospital and Brown University, Providence, RI.
| | - Ajay Nehra
- Department of Urology, Rush University, Chicago, Ill
| | | | - Shalender Bhasin
- Department of Medicine, Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Mass
| | - Kevin Billups
- Department of Urologic Surgery, University of Minnesota, Minneapolis; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Md
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Md
| | - Jacques Buvat
- Centre d'Etude et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique, Lille, France
| | - Culley Carson
- Department of Surgery, Division of Urologic Surgery, University of North Carolina, Chapel Hill
| | - Glenn Cunningham
- Departments of Medicine, and Molecular & Cellular Biology, Baylor College of Medicine and St. Luke's Episcopal Hospital, Houston, Tex
| | - Peter Ganz
- Division of Cardiology, San Francisco General Hospital and University of California, San Francisco, Calif
| | | | - Andre Guay
- Center For Sexual Function/Endocrinology, Lahey Clinic Medical Center, Peabody, Mass, Tufts University School of Medicine, Boston, Mass
| | | | - Robert A Kloner
- Heart Institute, Good Samaritan Hospital and Keck School of Medicine at University of Southern California, Los Angeles
| | - John B Kostis
- Cardiovascular Institute, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Piero Montorsi
- Centro Cardiologico Monzino, IRCCS, Institute of Cardiology University of Milan, Italy
| | - Melinda Ramsey
- Complete Healthcare Communications, Inc., Chadds Ford, Pa
| | - Raymond Rosen
- New England Research Institutes, Inc., Watertown, Mass
| | - Richard Sadovsky
- Department of Family Medicine, SUNY-Downstate Medical Center, Brooklyn, NY
| | - Allen Seftel
- Department of Urology, Cooper University Hospital, Camden, NJ
| | - Ridwan Shabsigh
- Division of Urology, Maimonides Medical Center, Brooklyn, NY, and College of Physicians and Surgeons of Columbia University, New York, NY
| | | | - Frederick Wu
- Andrology Research Unit, Developmental & Regenerative Biomedicine Research Group, University of Manchester, Manchester Academic Health Science Centre, Manchester Royal Infirmary, UK
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Jackson G. Erectile dysfunction and asymptomatic coronary artery disease: frequently detected by computed tomography coronary angiography but not by exercise electrocardiography. Int J Clin Pract 2013; 67:1159-62. [PMID: 23981083 DOI: 10.1111/ijcp.12275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/22/2013] [Accepted: 08/01/2013] [Indexed: 11/30/2022] Open
Abstract
AIMS Erectile dysfunction (ED) and vascular disease, in particular coronary artery disease (CAD), have the common denominator of endothelial dysfunction. ED frequently precedes a CAD event by between 2 and 5 years (average 3 years). ED also predicts an acute coronary syndrome as well as increased mortality, suggesting the rupture of an asymptomatic coronary plaque. This study compares multi-detector cardiac computed tomography (MDCT) with maximal treadmill exercising in men with ED and no coronary symptoms as a means of detecting coronary lesions. METHODS Sixty-five men with organic ED and no cardiac symptoms were prospectively screened for CAD. All underwent maximal exercise testing and MDCT in the same 7-day period. The Sexual Health Inventory for Men questionnaire established the presence of ED. FINDINGS The exercise ECG was borderline abnormal in three men and normal in 62. CT calcium was present in 53 (score 5-1671) and non-calcified plaque in seven. The MDCT angiogram was normal in only 5 (3.25%). CONCLUSION Erectile dysfunction may predict CAD in the absence of cardiac symptoms. MDCT detects subclinical plaque which may be vulnerable to rupture and which is not flow limiting enough to influence the exercise ECG. The window of 2-5 years between ED and a CAD event offers an opportunity for aggressive risk factor reduction. ED should be a routine question in any risk calculator.
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Affiliation(s)
- G Jackson
- London Bridge Hospital, London, UK; Guy's and St Thomas' Hospitals NHS Trust, London, UK
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15
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Jackson G, Nehra A, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham G, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis JB, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FCW. The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician. Int J Clin Pract 2013; 67:1163-72. [PMID: 23714173 DOI: 10.1111/ijcp.12200] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 04/23/2013] [Indexed: 12/26/2022] Open
Abstract
Erectile dysfunction (ED) and cardiovascular disease (CVD) share risk factors and frequently coexist, with endothelial dysfunction believed to be the pathophysiologic link. ED is common, affecting more than 70% of men with known CVD. In addition, clinical studies have demonstrated that ED in men with no known CVD often precedes a CVD event by 2-5 years. ED severity has been correlated with increasing plaque burden in patients with coronary artery disease. ED is an independent marker of increased CVD risk including all-cause and especially CVD mortality, particularly in men aged 30-60 years. Thus, ED identifies a window of opportunity for CVD risk mitigation. We recommend that a thorough history, physical exam (including visceral adiposity), assessment of ED severity and duration and evaluation including fasting plasma glucose, lipids, resting electrocardiogram, family history, lifestyle factors, serum creatinine (estimated glomerular filtration rate) and albumin:creatinine ratio, and determination of the presence or absence of the metabolic syndrome be performed to characterise cardiovascular risk in all men with ED. Assessment of testosterone levels should also be considered and biomarkers may help to further quantify risk, even though their roles in development of CVD have not been firmly established. Finally, we recommend that a question about ED be included in assessment of CVD risk in all men and be added to CVD risk assessment guidelines.
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Affiliation(s)
- G Jackson
- Department of Cardiology, Guy's and St Thomas' Hospitals London, London, UK
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Gandaglia G, Briganti A, Jackson G, Kloner RA, Montorsi F, Montorsi P, Vlachopoulos C. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol 2013; 65:968-78. [PMID: 24011423 DOI: 10.1016/j.eururo.2013.08.023] [Citation(s) in RCA: 298] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/12/2013] [Indexed: 02/07/2023]
Abstract
CONTEXT Erectile dysfunction (ED) is considered a vascular impairment that shares many risk factors with cardiovascular disease (CVD). A correlation between ED and CVD has been hypothesized, and ED has been proposed as an early marker of symptomatic CVD. OBJECTIVE To analyze the relationship between ED and CVD, evaluating the pathophysiologic links between these conditions, and to identify which patients would benefit from cardiologic assessment when presenting with ED. EVIDENCE ACQUISITION A systematic literature review searching Medline, Embase, and Web of Science databases was performed. The search strategy included the terms erectile dysfunction, cardiovascular disease, coronary artery disease, risk factors, pathophysiology, atherosclerosis, low androgen levels, inflammation, screening, and phosphodiesterase type 5 inhibitors alone or in combination. We limited our search to studies published between January 2005 and May 2013. EVIDENCE SYNTHESIS Several studies reported an association between ED and CVD. The link between these conditions might reside in the interaction between androgens, chronic inflammation, and cardiovascular risk factors that determines endothelial dysfunction and atherosclerosis, resulting in disorders of penile and coronary circulation. Because penile artery size is smaller compared with coronary arteries, the same level of endothelial dysfunction causes a more significant reduction of blood flow in erectile tissues compared with that in coronary circulation. Thus ED could be an indicator of systemic endothelial dysfunction. From a clinical standpoint, because ED may precede CVD, it can be used as an early marker to identify men at higher risk of CVD events. ED patients at high risk of CVD should undergo detailed cardiologic assessment and receive intensive treatment of risk factors. CONCLUSIONS ED and CVD should be regarded as two different manifestations of the same systemic disorder. ED usually precedes CVD onset, and it might be considered an early marker of symptomatic CVD.
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Affiliation(s)
- Giorgio Gandaglia
- Urological Research Institute, University Vita-Salute San Raffaele, Department of Urology, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Urological Research Institute, University Vita-Salute San Raffaele, Department of Urology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Robert A Kloner
- Good Samaritan Hospital, Los Angeles, Department of Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Francesco Montorsi
- Urological Research Institute, University Vita-Salute San Raffaele, Department of Urology, San Raffaele Scientific Institute, Milan, Italy
| | - Piero Montorsi
- Centro Cardiologico Monzino, Institute of Cardiology, University of Milan, Milan, Italy
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La Favor JD, Anderson EJ, Dawkins JT, Hickner RC, Wingard CJ. Exercise prevents Western diet-associated erectile dysfunction and coronary artery endothelial dysfunction: response to acute apocynin and sepiapterin treatment. Am J Physiol Regul Integr Comp Physiol 2013; 305:R423-34. [PMID: 23761637 PMCID: PMC4839473 DOI: 10.1152/ajpregu.00049.2013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 06/05/2013] [Indexed: 02/07/2023]
Abstract
The aim of this study was to investigate aerobic exercise training as a means to prevent erectile dysfunction (ED) and coronary artery disease (CAD) development associated with inactivity and diet-induced obesity. Male Sprague-Dawley rats were fed a Western diet (WD) or a control diet (CD) for 12 wk. Subgroups within each diet remained sedentary (Sed) or participated in aerobic interval treadmill running throughout the dietary intervention. Erectile function was evaluated under anesthesia by measuring the mean arterial pressure and intracavernosal pressure in response to electrical field stimulation of the cavernosal nerve, in the absence or presence of either apocynin, an NADPH oxidase inhibitor, or sepiapterin, a tetrahydrobiopterin precursor. Coronary artery endothelial function (CAEF) was evaluated ex vivo with cumulative doses of ACh applied to preconstricted segments of the left anterior descending coronary artery. CAEF was assessed in the absence or presence of apocynin or sepiapterin. Erectile function (P < 0.0001) and CAEF (P < 0.001) were attenuated in WD-Sed. Exercise preserved erectile function (P < 0.0001) and CAEF (P < 0.05) within the WD. Erectile function (P < 0.01) and CAEF (P < 0.05) were augmented by apocynin only in WD-Sed, while sepiapterin (P < 0.05) only augmented erectile function in WD-Sed. These data demonstrate that a chronic WD induces impairment in erectile function and CAEF that are commonly partially reversible by apocynin, whereas sepiapterin treatment exerted differential functional effects between the two vascular beds. Furthermore, exercise training may be a practical means of preventing diet-induced ED and CAD development.
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Affiliation(s)
- Justin D. La Favor
- Department of Kinesiology, East Carolina University, Greenville, North Carolina
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Ethan J. Anderson
- Department of Pharmacology and Toxicology, East Carolina University, Greenville, North Carolina; and
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Jillian T. Dawkins
- Department of Kinesiology, East Carolina University, Greenville, North Carolina
- Department of Physiology, East Carolina University, Greenville, North Carolina; and
| | - Robert C. Hickner
- Department of Kinesiology, East Carolina University, Greenville, North Carolina
- Department of Physiology, East Carolina University, Greenville, North Carolina; and
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Christopher J. Wingard
- Department of Physiology, East Carolina University, Greenville, North Carolina; and
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
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Martin Morales A, Hatzichristou D, Ramon Lladós J, Pascual Renedo V, Pimenidou A. Community pharmacy detection of erectile dysfunction in men with risk factors or who seek treatment or advice but lack a valid prescription. J Sex Med 2013; 10:2303-11. [PMID: 23845082 DOI: 10.1111/jsm.12238] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pharmacists may be the first health care contact consulted about erectile dysfunction (ED). AIM To assess pharmacists' ability to detect ED and encourage patients to seek medical evaluation. METHODS This observational study conducted in Greece and Spain included men without a valid prescription for an ED medication but with a history indicating ED risk and/or who consulted a pharmacist about ED. Pharmacists completed a questionnaire about the patient. Patients completed the Sexual Health Inventory for Men (SHIM); men with a score ≤21 (cutoff for ED) were educated (by case pharmacists) and referred and encouraged to see a physician (by case and control pharmacists). MAIN OUTCOME MEASURES Proportion of men with a SHIM score ≤21 and, of those, the proportion who visited a physician and credited the pharmacist for their visit. ANCOVA and chi-square test were used for continuous and categorical data, respectively. RESULTS Among the 451 men (mean ± SD age, 54.9 ± 12.9 years) questioned about ED, 90% had a risk factor (usually hypertension, hypercholesterolemia, or diabetes), 28% had a previous diagnosis, 36% sought internet information, 38% self-medicated, 10% took medication obtained outside the pharmacy setting, and the first health care professional approached was a pharmacist (50%), physician (18%), or nurse (1%) at a median of 6 (range, 0-360) months after symptom onset. The SHIM score was ≤21 in 348 (77%) men. A lower score (indicating increased ED severity) was associated with increased age and with benign prostate hyperplasia, depression, diabetes, or prostate cancer. In the minority of men contacted for follow-up, less than one-third had visited their physician, despite pharmacist encouragement. CONCLUSIONS Pharmacists are often the first health care contact regarding ED and are highly accurate in its detection. Further research is needed to optimize the pharmacist's role in early detection, education, and motivating patients to be evaluated by a physician.
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Jackson G. Erectile dysfunction and cardiovascular disease. Arab J Urol 2013; 11:212-6. [PMID: 26558084 PMCID: PMC4442980 DOI: 10.1016/j.aju.2013.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 03/24/2013] [Accepted: 03/27/2013] [Indexed: 01/01/2023] Open
Abstract
The link between erectile dysfunction (ED) and cardiovascular disease (CVD) is reviewed by assessing original papers, current consensus, previous reviews and meta-analyses. The link between these conditions is confirmed, and the evaluation and assessment summarised with a new evidence-based algorithm. ED, especially in younger men, is a marker of an increased risk of CVD, and ED needs to be incorporated into all risk-screening programmes.
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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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Scranton RE, Goldstein I, Stecher VJ. Erectile Dysfunction Diagnosis and Treatment as a Means to Improve Medication Adherence and Optimize Comorbidity Management. J Sex Med 2013; 10:551-61. [DOI: 10.1111/j.1743-6109.2012.02998.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Rastrelli G, Boddi V, Corona G, Mannucci E, Maggi M. Impaired masturbation-induced erections: a new cardiovascular risk factor for male subjects with sexual dysfunction. J Sex Med 2013; 10:1100-13. [PMID: 23347226 DOI: 10.1111/jsm.12052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is considered an early surrogate marker of silent, or even overt, cardiovascular diseases (CVD). However, epidemiological studies take into account only sexual intercourse-related erections. Although autoeroticism is a very common practice, data on masturbation-induced erections as a possible predictor of major adverse cardiovascular events (MACE) are lacking. AIM To evaluate the clinical correlates of impaired masturbation-induced erections and to verify the importance of this sexual aspect in predicting MACE. METHODS A consecutive series of 4,031 male patients attending the Outpatient Clinic for sexual dysfunction for the first time was retrospectively studied. Among these subjects, 64% reported autoeroticism during the last 3 months, and only this subset was considered in the following analyses. In the longitudinal study, 862 subjects reporting autoeroticism were enrolled. MAIN OUTCOME MEASURES Several clinical, biochemical, and instrumental (Prostaglandin E1 [PGE1 ] test and penile color Doppler ultrasound) parameters were studied. RESULTS Subjects with an impaired erection during masturbation (46% of those reporting autoeroticism) had more often a positive personal or family history of CVD, a higher risk of reduced intercourse- and sleep-related erections, hypoactive sexual desire and perceived reduced ejaculate volume, and impaired PGE1 test response. Prolactin levels were lower in those having impaired erection during masturbation. In the longitudinal study, unadjusted incidence of MACE was significantly associated with impaired masturbation-induced erections. When dividing the population according to the median age and diagnosis of diabetes, the association between impaired masturbation-induced erections and incidence of MACE was maintained only in the youngest (<55 years old) and in nondiabetic subjects, even after adjusting for confounders (hazard ratio [HR] = 3.348 [1.085-10.335], P = 0.032 and HR = 2.108 [1.002-4.433], P = 0.049; respectively). CONCLUSION This study indicates that, in subjects with male sexual dysfunction, evaluating an often neglected sexual parameter, such as masturbation-induced erections, can provide further insights on forthcoming MACE in particular in "low risk" subjects.
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Affiliation(s)
- Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, Florence, Italy
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La Favor JD, Anderson EJ, Hickner RC, Wingard CJ. Erectile dysfunction precedes coronary artery endothelial dysfunction in rats fed a high-fat, high-sucrose, Western pattern diet. J Sex Med 2012; 10:694-703. [PMID: 23170997 DOI: 10.1111/jsm.12001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction. It is suggested that erectile dysfunction (ED) may be an early risk factor for cardiovascular disease. Aim. The goal of this study was to determine whether development of ED precedes the onset of coronary artery endothelial dysfunction in response to a Western diet (WD), thereby establishing whether the WD differentially impacts the endothelium in a time-dependent manner. Additionally, a goal was to determine if diet-induced ED is reversible with intracavernosal sepiapterin treatment. Methods. Male Sprague-Dawley rats were fed a WD for 4, 8, or 12 weeks, or a control diet for 8 weeks. Erectile function was evaluated by measuring the mean arterial pressure (MAP) and intracavernosal pressure (ICP) in response to electrical field stimulation of the cavernosal nerve near the major pelvic ganglion, in the absence and presence of sepiapterin. Coronary artery endothelial function was evaluated ex vivo with cumulative doses of acetylcholine (ACh) applied to segments of the left anterior descending coronary artery preconstricted with serotonin. Main Outcome Measures. Erectile function was assessed as the ICP response to electrical field stimulation (EFS), normalized to MAP. Coronary artery endothelial function was assessed as the effective concentration producing 50% of a maximal response (EC50 ) of the ACh response. Results. The ICP/MAP response to EFS was significantly attenuated following both 8 and 12 weeks of the WD compared with the control diet (P < 0.05). Sepiapterin treatment augmented the ICP/MAP response in all WD groups (P < 0.05). The coronary artery EC50 of the ACh response was not different from control following 4 or 8 weeks but was significantly elevated following 12 weeks of the WD (P < 0.01). Conclusions. These data suggest that erectile function is reduced prior to coronary artery endothelial function in response to the WD. Improvement of erectile function with sepiapterin in WD rats indicates that nitric oxide synthase uncoupling is a key mechanism in diet-induced ED. La Favor JD, Anderson EJ, Hickner RC, and Wingard CJ. Erectile dysfunction precedes coronary artery endothelial dysfunction in rats fed a high-fat, high-sucrose, Western pattern diet. J Sex Med 2013;10:694-703.
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Affiliation(s)
- Justin D La Favor
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC 27834, USA
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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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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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Miner M, Seftel AD, Nehra A, Ganz P, Kloner RA, Montorsi P, Vlachopoulos C, Ramsey M, Sigman M, Tilkemeier P, Jackson G. Prognostic utility of erectile dysfunction for cardiovascular disease in younger men and those with diabetes. Am Heart J 2012; 164:21-8. [PMID: 22795278 DOI: 10.1016/j.ahj.2012.04.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/12/2012] [Indexed: 01/02/2023]
Abstract
Multiple published studies have established erectile dysfunction (ED) as an independent risk marker for cardiovascular disease (CVD). In fact, incident ED has a similar or greater predictive value for cardiovascular events than traditional risk factors including smoking, hyperlipidemia, and family history of myocardial infarction. Here, we review evidence that supports ED as a particularly significant harbinger of CVD in 2 populations: men <60 years of age and those with diabetes. Although addition of ED to the Framingham Risk Score only modestly improved the 10-year predictive capacity of the Framingham Risk Score for myocardial infarction or coronary death data in men enrolled in the Massachusetts Male Aging Study, other epidemiologic studies suggest that the predictive value of ED is quite strong in younger men. Indeed, in the Olmstead County Study, men 40 to 49 years of age with ED had a 50-fold higher incidence of new-incident coronary artery disease than those without ED. However, ED had less predictive value (5-fold increased risk) for coronary artery disease in men 70 years and older. Several studies, including a large analysis of more than 6300 men enrolled in the ADVANCE study, suggest that ED is a particularly powerful predictor of CVD in diabetic men as well. Based on the literature reviewed here, we encourage physicians to inquire about ED symptoms in all men more than 30 years of age with cardiovascular risk factors. Identification of ED, particularly in men <60 years old and those with diabetes, represents an important first step toward CVD risk detection and reduction.
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Affiliation(s)
- Martin Miner
- Department of Family Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
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27
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Jackson G. Erectile dysfunction and coronary disease: evaluating the link. Maturitas 2012; 72:263-4. [PMID: 22503513 DOI: 10.1016/j.maturitas.2012.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 03/22/2012] [Indexed: 12/12/2022]
Abstract
Erectile dysfunction (ED) is common, affecting 40% of men over 40 years of age (so-called 40 over 40) and 1 in 3 men over 70 years of age. It is predominantly a vascular condition, often preceding a cardiovascular event by 3-5 years. ED is associated as a consequence with acute coronary syndromes and increased cardiovascular and all-cause mortality. Its early identification therefore offers a window of opportunity for cardiovascular risk reduction. ED has for many a devastating impact on a couple's relationship. Its treatment is often successful, maintaining quality of life in the middle aged and elderly. ED should always be queried as part of the ongoing health care worker and patient relationship - its early detection may prevent early death.
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Affiliation(s)
- Graham Jackson
- Guy's and St Thomas' Hospitals NHS Trust, United Kingdom.
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White A, De Sousa B, De Visser R, Hogston R, Madsen SA, Makara P, McKee M, Raine G, Richardson N, Clarke N, Zatoński W. Men's health in Europe. JOURNAL OF MENS HEALTH 2011. [DOI: 10.1016/j.jomh.2011.08.113] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pohjantähti-Maaroos H, Palomäki A. Comparison of metabolic syndrome subjects with and without erectile dysfunction - levels of circulating oxidised LDL and arterial elasticity. Int J Clin Pract 2011; 65:274-80. [DOI: 10.1111/j.1742-1241.2010.02595.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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30
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Sexual dysfunction in uraemic patients undergoing haemodialysis: predisposing and related conditions. Andrologia 2010; 42:166-75. [PMID: 20500745 DOI: 10.1111/j.1439-0272.2009.00974.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Chronic kidney disease and sexual dysfunction are common entities in clinical practice in haemodialysis (HD) units. This article is a review of some articles that focus on sexual dysfunction in patients undergoing HD and its possible relationship in multiple ways.
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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: 138] [Impact Index Per Article: 9.9] [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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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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Does erectile dysfunction contribute to cardiovascular disease risk prediction beyond the Framingham risk score? J Am Coll Cardiol 2010; 55:350-6. [PMID: 20117441 DOI: 10.1016/j.jacc.2009.08.058] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 08/26/2009] [Accepted: 08/30/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study was designed to determine whether erectile dysfunction (ED) predicts cardiovascular disease (CVD) beyond traditional risk factors. BACKGROUND Both ED and CVD share pathophysiological mechanisms and often co-occur. It is unknown whether ED improves the prediction of CVD beyond traditional risk factors. METHODS This was a prospective, population-based study of 1,709 men (of 3,258 eligible) age 40 to 70 years. The ED data were measured by self-report. Subjects were followed for CVD for an average follow-up of 11.7 years. The association between ED and CVD was examined using the Cox proportional hazards regression model. The discriminatory capability of ED was examined using C statistics. The reclassification of CVD risk associated with ED was assessed using a method that quantifies net reclassification improvement. RESULTS Of the prospective population, 1,057 men with complete risk factor data who were free of CVD and diabetes at baseline were included. During follow-up, 261 new cases of CVD occurred. We found ED was associated with CVD incidence controlling for age (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.05 to 1.90), age and traditional CVD risk factors (HR: 1.41, 95% CI: 1.05 to 1.90), as well as age and Framingham risk score (HR: 1.40, 95% CI: 1.04 to 1.88). Despite these significant findings, ED did not significantly improve the prediction of CVD incidence beyond traditional risk factors. CONCLUSIONS Independent of established CVD risk factors, ED is significantly associated with increased CVD incidence. Nonetheless, ED does not improve the prediction of who will and will not develop CVD beyond that offered by traditional risk factors.
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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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Miner MM. Erectile dysfunction: a harbinger for cardiovascular events and other comorbidities, thereby allowing a 'Window of Curability'. Int J Clin Pract 2009; 63:1123-6. [PMID: 19624780 DOI: 10.1111/j.1742-1241.2009.02084.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Araujo AB, Travison TG, Ganz P, Chiu GR, Kupelian V, Rosen RC, Hall SA, McKinlay JB. Erectile dysfunction and mortality. J Sex Med 2009; 6:2445-54. [PMID: 19538544 DOI: 10.1111/j.1743-6109.2009.01354.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) and cardiovascular disease (CVD) share pathophysiological mechanisms and often co-occur. Yet it is not known whether ED provides an early warning for increased CVD or other causes of mortality. AIM We sought to examine the association of ED with all-cause and cause-specific mortality. METHODS Prospective population-based study of 1,709 men (of 3,258 eligible) aged 40-70 years. ED was measured by self-report. Subjects were followed for a mean of 15 years. Hazard ratios (HR) were calculated using the Cox proportional hazards regression model. MAIN OUTCOME MEASURES Mortality due to all causes, CVD, malignant neoplasms, and other causes. RESULTS Of 1,709 men, 1,284 survived to the end of 2004 and had complete ED and age data. Of 403 men who died, 371 had complete data. After adjustment for age, body mass index, alcohol consumption, physical activity, cigarette smoking, self-assessed health, and self-reported heart disease, hypertension, and diabetes, ED was associated with HRs of 1.26 (95% confidence interval [CI] 1.01-1.57) for all-cause mortality, and 1.43 (95% CI 1.00-2.05) for CVD mortality. The HR for CVD mortality associated with ED is of comparable magnitude to HRs of some conventional CVD risk factors. CONCLUSIONS These findings demonstrate that ED is significantly associated with increased all-cause mortality, primarily through its association with CVD mortality.
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Affiliation(s)
- Andre B Araujo
- New England Research Institutes, Watertown, MA 02472, USA.
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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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Abstract
The cardiovascular response to sexual activity in men and women is similar to other daily activities and not excessive between couples in a long-standing relationship. The risk of an ischemic event during sexual activity is low and death very uncommon. Sexual dysfunction is common in cardiac patients and, in men, may occur before cardiac symptoms, with a time interval of 2 to 5 years. Exercise testing fails to identify nonobstructive but vulnerable-to-rupture lipid-rich plaques. Cardiac computed tomography identifies these silent plaques and triggers an aggressive risk-reducing management plan. As erectile dysfunction in men over 40 years of age is usually of vascular (endothelial dysfunction) origin, they should be considered "cardiovascular equivalents," and secondary prevention guidelines should be followed.
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Hatzichristou D. Understanding individuals' response to erectile dysfunction. Int J Impot Res 2008; 20 Suppl 2:S15-20. [DOI: 10.1038/ijir.2008.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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43
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Jackson G. Prevention of cardiovascular disease by the early identification of erectile dysfunction. Int J Impot Res 2008; 20 Suppl 2:S9-14. [DOI: 10.1038/ijir.2008.47] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jackson G. Preventing coronary heart disease in women. Int J Clin Pract 2008; 62:1299-300. [PMID: 18793371 DOI: 10.1111/j.1742-1241.2008.01874.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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