A multidisciplinary approach to assess erectile dysfunction in high-risk cardiovascular patients

Schwarz, Ernst R.; Rastogi, S; Rodriguez, Jennifer; Kapur, Vishal; Sulemanjee, Nasir; Gupta, Rajiv; Rosanio, Salvatore

doi:10.1038/sj.ijir.3901427

Cited by 13 publications

(9 citation statements)

References 54 publications

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“…Although no large-scale data have reported severe bleeding episodes in patients taking aspirin and clopidogrel, patients treated with warfarin would not be ideal candidates for these therapies owing to increased bleeding risks. In general, these therapies are best guided by the expertise of a urologist in close collaboration with the patient's cardiologist (110). Surgical management of ED.…”

Section: Treating Erectile Dysfunction In the Heart Failure Patientmentioning

confidence: 99%

Erectile Dysfunction in Heart Failure Patients

Schwarz

Rastogi

Kapur

et al. 2006

Journal of the American College of Cardiology

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Chronic heart failure (HF) and erectile dysfunction (ED) are 2 highly prevalent disorders that frequently occur concomitantly. Coronary artery disease, HF, and ED share several common risk factors, including diabetes mellitus, hypertension, smoking, and dyslipidemia. Additionally, the distinct physiologic sequelae of HF create unique organic and psychologic factors contributing to ED in this patient population. Standard HF therapy with beta-receptor blockers, digoxin and thiazide diuretics may worsen sexual dysfunction owing to medication side effects. This may, in turn, lead to noncompliance in misguided efforts to retain satisfactory sexual activity, with secondary worsening of cardiac capacity. This review describes the unique aspects of ED in the HF population.

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Section: Treating Erectile Dysfunction In the Heart Failure Patientmentioning

confidence: 99%

Erectile Dysfunction in Heart Failure Patients

Schwarz

Rastogi

Kapur

et al. 2006

Journal of the American College of Cardiology

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“…However, treatment should be tailored to the individual patient, as certain drugs used in the treatment of cardiovascular disease may be associated with the development of ED or exacerbation of existing ED. These include beta-blockers, thiazide diuretics, calcium channel blockers, statins, fibrates and ACE inhibitors (6,(49)(50)(51)(52)(53)(54)(55)(56) (Table 1). However, unless ED developed within 4 weeks of initiating drug therapy, there is little evidence to support switching the suspect drug to alleviate the symptoms of ED (57).…”

Section: Message For the Clinicmentioning

confidence: 99%

Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus

Jackson

Boon

Eardley

et al. 2010

International Journal of Clinical Practice

208

157

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Summary 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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“…Patients with and without ED at hospital admission had no significant differences in the prevalence of CV risk factors or CVD. It is possible that testosterone deficiency in this group of patients had greater significance in the pathogenesis of ED than atherosclerosis and endothelial dysfunction [20]. Presumably, the treatment of patients with CVD or the risk factors could have had an influence on erectile function.…”

Section: Discussionmentioning

confidence: 86%

“…The possible scores for the questionnaire range from 1 to 25 (each question has a score of 1-5), and a score above 21 was considered as normal erectile function and at or below this cut-off point as ED. According to this scale, ED is classified into four categories based on the total score: severe (1-7), moderate (8-11), mild to moderate (12)(13)(14)(15)(16), mild (17)(18)(19)(20)(21), and no ED (22)(23)(24)(25) [17].…”

Section: Methodsmentioning

confidence: 99%