Sexual Dysfunction and Cardiac Risk (the Second Princeton Consensus Conference)

Abstract

Recent studies have highlighted the relation between erectile dysfunction (ED) and cardiovascular disease. In particular, the role of endothelial dysfunction and nitric oxide in ED and atherosclerotic disease has been elucidated. Given the large number of men receiving medical treatment for ED, concerns regarding the risk for sexual activity triggering acute cardiovascular events and potential risks of adverse or unanticipated drug interactions need to be addressed. A risk stratification algorithm was developed by the First Princeton Consensus Panel to evaluate the degree of cardiovascular risk associated with sexual activity for men with varying degrees of cardiovascular disease. Patients were assigned to 3 categories: low, intermediate (including those requiring further evaluation), and high risk. This consensus study from the Second Princeton Consensus Conference corroborates and clarifies the algorithm and emphasizes the importance of risk factor evaluation and management for all patients with ED. The panel reviewed recent safety and drug interaction data for 3 phosphodiesterase (PDE)-5 inhibitors (sildenafil, tadalafil, vardenafil), with emphasis on the safety of these agents in men with ED and concomitant cardiovascular disease. Increasing evidence supports the role of lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease. Special management recommendations for patients taking PDE-5 inhibitors who present at the emergency department and other emergency medical situations are described. Finally, further research on the role of PDE-5 inhibition in treating patients with other medical or cardiovascular disorders is recommended.

A review of the positive and negative effects of cardiovascular drugs on sexual function: a proposed table for use in clinical practice

“…Based on the absence of hard data coming from randomised controlled studies, the Second Princeton Consensus Management Recommendation states that ‘a change in class of antihypertensive medication rarely results in the restoration of sexual function’ [81]. However, the available data point towards significant benefits in sexual function when switching prior antihypertensive therapy [4, 48, 51, 82].…”

Patterns and Loss of Sexual Activity in the Year Following Hospitalization for Acute Myocardial Infarction (a United States National Multisite Observational Study)

“…10,23,27,28 This study is the first to prospectively assess, in a large population of men and women with AMI, the association of post-AMI sexual activity with 12-month mortality. Although limited by the small number of deaths, our study does not raise any safety concerns.…”

Cardiometabolic Risk Factors in Patients with Erectile Dysfunction

“…ED share, similar modifiable risk factors with coronary artery disease (CAD) and generalised vascular illness including hypertension, diabetes, hyperlipidemia, obesity, lack of physical exercise, cigarette smoking, poor diet, excess alcohol intake, and psychological stress [1, 2]. There is consensus to consider all men with ED at risk of cardiovascular disease (CVD) until proven otherwise [3, 4]. An association between erectile dysfunction and ischemic heart disease has been suggested as a consequence of vascular lesions of the penile arteries [5].…”