¹Heart Institute, Good Samaritan Hospital (USC), Los Angeles, CA, USA

Correspondence: R Kloner, Heart Institute, Good Samaritan Hospital (USC), 1225 Wilshire Blvd., Los Angeles, CA 90017, USA. E-mail: rkloner@goodsam.org

Received 7 January 2005; Revised 11 January 2005; Accepted 11 January 2005; Published online 24 February 2005.

Abstract

Recent studies suggest that erectile dysfunction (ED) may be an early marker of endothelial dysfunction and coronary artery disease (CAD). Conversely, patients with CAD commonly have ED. The phosphodiesterase 5 (PDE5) inhibitors are very effective for the treatment of ED in patients with CAD. Numerous studies show that this class of drugs is in general safe in patients with stable CAD and these agents do not exacerbate ischemia in men with CAD undergoing exercise stress testing. Analysis of placebo-controlled trials did not show an increase in cardiovascular events among men receiving PDE5 inhibitors, and post-marketing surveillance studies with sildenafil did not observe an increase in cardiovascular events compared to expected age-matched rates. Organic nitrates remain a contraindication for PDE5 inhibitors and alpha blockers have precautions/contraindications depending upon specific drugs. The Princeton Consensus Guidelines (soon to be updated) suggest a logical approach to the patient with CAD seeking therapy for sexual dysfunction.