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Erectile dysfunction in patients with coronary artery disease

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.

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References

  1. Feldman HA et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.

    Article  CAS  PubMed  Google Scholar 

  2. Kloner RA, Jarow JP . Erectile dysfunction and sildenafil citrate and cardiologists. Am J Cardiol 1999; 83: 576–582.

    Article  CAS  PubMed  Google Scholar 

  3. Blumentals WA, Gomez-Caminero A, Joo S, Vannappagari V . Should erectile dysfunction be considered as a marker for acute myocardial infarction? Results from a retrospective cohort study. Int J Impot Res 2004; 16: 350–353.

    Article  CAS  PubMed  Google Scholar 

  4. Kaiser DR et al. Impaired brachial artery endothelium-dependent and -independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J Am Coll Cardiol 2004; 43: 179–184.

    Article  PubMed  Google Scholar 

  5. O’Kane PD, Jackson G . Erectile dysfunction: is there silent obstructive coronary artery disease? Int J Clin Pract 2001; 55: 219–220.

    PubMed  Google Scholar 

  6. Pritzker MR . The penile stress test: a window to the hearts of Man? Circulation 1999; 100(Suppl 1): 1–711.

    Google Scholar 

  7. Montorsi P, Montorsi F, Schulman CC . Is erectile dysfunction the ‘Tip of the Iceberg’ of a systemic vascular disorder? Eur Urol 2003; 44: 352–354.

    Article  PubMed  Google Scholar 

  8. Dhabuwala CB, Kumar A, Pierce JM . Myocardial infarction and its influence on male sexual function. Arch Sexual Behav 1986; 15: 499–504.

    Article  CAS  Google Scholar 

  9. Kloner RA et al. Erectile dysfunction in the cardiac patient: how common and should we treat? J Urol 2003; 170: S46–S50.

    Article  PubMed  Google Scholar 

  10. Conti CR, Pepine CJ, Sweeney M . Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease. Am J Cardiol 1999; 83: 29C–34C.

    Article  CAS  PubMed  Google Scholar 

  11. DeBusk RF et al. Efficacy and safety of sildenafil citrate in men with erectile dysfunction and stable coronary artery disease. Am J Cardiol 2004; 93: 147–153.

    Article  CAS  PubMed  Google Scholar 

  12. Olsson AM, Persson C-A . Efficacy and safety of sildenafil citrate for the treatment of erectile dysfunction in men with cardiovascular disease. Int J Clin Pract 2001; 55: 171–176.

    CAS  PubMed  Google Scholar 

  13. Arruda-Olson AM et al. Cardiovascular effects of sildenafil during exercise in men with known or probable coronary artery disease. A randomized crossover trial. JAMA 2002; 287: 719–725.

    Article  CAS  PubMed  Google Scholar 

  14. Fox KM, et al, on behalf of the CAESAR 1 Clinical American and European Studies of Angina and Revascularization investigators. Sildenafil citrate does not reduce exercise tolerance in men with erectile dysfunction and chronic stable angina. Eur Heart J 2003; 24: 2206–2212.

    Article  CAS  PubMed  Google Scholar 

  15. Patrizi R et al. Effect of sildenafil citrate upon myocardial ischemia in patients with chronic stable angina in therapy with beta-blockers. Ital Heart J 2001; 2: 841–844.

    CAS  PubMed  Google Scholar 

  16. Thadani U et al. The effect of vardenafil, a potent and highly selective phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction, on the cardiovascular response to exercise in patients with coronary artery disease. J Am Coll Cardiol 2002; 40: 2006–2012.

    Article  CAS  PubMed  Google Scholar 

  17. Patterson D et al. Tadalafil does not affect time to ischemia during exercise stress testing in patients with coronary artery disease. Circulation 2002; 106(Suppl II): II-330.

    Google Scholar 

  18. Herrmann HC, Chang G, Klugherz BD, Mahoney PD . Hemodynamic effects of sildenafil in men with severe coronary artery disease. N Engl J Med 2000; 342: 1622–1626.

    Article  CAS  PubMed  Google Scholar 

  19. Cheitlin MD et al. Use of sildenafil (Viagra) in patients with cardiovascular disease. J Am J Coll Cardiol 1999; 33: 273–282.

    Article  CAS  Google Scholar 

  20. Halcox JPJ et al. The effect of sildenafil on human vascular function, platelet activation, and myocardial ischemia. J Am Coll Cardiol 2002; 40: 1232–1240.

    Article  CAS  PubMed  Google Scholar 

  21. Mittleman MA, Glasser DB, Orazem J . Clinical trials of sildenafil citrate (Viagra®) demonstrate no increase in risk of myocardial infarction and cardiovascular death compared with placebo. Int J Clin Pract 2003; 57: 597–600.

    CAS  PubMed  Google Scholar 

  22. Morales A et al. Clinical safety of oral sildenafil citrate (VIAGRA) in the treatment of erectile dysfunction. Int J Impot Res 1998; 10: 69–74.

    Article  CAS  PubMed  Google Scholar 

  23. Padma-Nathan H et al. A 4-year update on the safety of sildenafil citrate (Viagra®). Urology 2002; 60(Suppl 3B): 67–90.

    Article  PubMed  Google Scholar 

  24. Steers W et al. Assessment of the efficacy and safety of Viagra (sildenafil citrate) in men with erectile dysfunction during long-term treatment. Int J Impot Res 2001; 13: 261–267.

    Article  CAS  PubMed  Google Scholar 

  25. Christiansen E et al. Long-term efficacy and safety of oral Viagra (sildenafil citrate) in men with erectile dysfunction and the effect of randomized treatment withdrawal. Int J Impot Res 2000; 12: 177–182.

    Article  CAS  PubMed  Google Scholar 

  26. Emmick JT, Stuewe SR, Mitchell M . Overview of the cardiovascular effects of tadalafil. Eur Heart J Suppl 2002; 4(Suppl H): H32–H47.

    Article  CAS  Google Scholar 

  27. Sadovsky R, Miller T, Moskowitz M, Hackett G . Three-year update of sildenafil citrate (Viagra) efficacy and safety. Int J Clin Pract 2001; 55: 115–128.

    CAS  PubMed  Google Scholar 

  28. Kloner RA, Mitchell M, Emmick JT . Cardiovascular effects of tadalafil. Am J Cardiol 2003; 92(Suppl): 37M–46M.

    Article  CAS  PubMed  Google Scholar 

  29. Jackson G et al. Update on clinical trials of tadalafil demonstrates no increased risk of cardiovascular adverse events. J Sex Med 2004; 1: 161–167.

    Article  CAS  PubMed  Google Scholar 

  30. McMahon C . Efficacy and safety of daily tadalafil in men with erectile dysfunction previously unresponsive to on-demand tadalafil. J Sex Med 2004; 1: 292–300.

    Article  CAS  PubMed  Google Scholar 

  31. Kloner RA et al. Cardiovascular safety of vardenafil, a potent, highly selective PDE5 inhibitor in patients with erectile dysfunction: analysis of five controlled trials. Pharmacol Ther 2002; 22: 1371.

    Google Scholar 

  32. Wysowski DK, Farinas E, Swartz L . Comparison of reported and expected deaths in sildenafil (Viagra) users. Am J Cardiol 2002; 89: 1331–1334.

    Article  CAS  PubMed  Google Scholar 

  33. Shakir SAW et al. Cardiovascular events in users of sildenafil: results from first phase of prescription event monitoring in England. BMJ 2001; 322: 651–652.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Shakir SAW et al. Cardiovascular events in users of sildenafil: results from first phase of prescription event monitoring in England. BMJ 2001; 322: 651–652.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Webb DJ et al. Sildenafil citrate potentiates the hypotensive effects of nitric oxide donor drugs in male patients with stable angina. J Am Coll Cardiol 2000; 36: 25–31.

    Article  CAS  PubMed  Google Scholar 

  36. Ishikura F et al. Effects of sildenafil citrate (Viagra) combined with nitrate on the heart. Circulation 2000; 102: 2516–2521.

    Article  CAS  PubMed  Google Scholar 

  37. Oliver JJ et al. Interaction between glyceryl trinitrate and sildenafil citrate (Viagra) may last less than four hours. Int J Impot Res 2002; 14(Suppl 3): S22–S28.

    Google Scholar 

  38. Kloner RA et al. Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol 2003; 42: 1855–1860.

    Article  CAS  PubMed  Google Scholar 

  39. Kloner RA . Cardiovascular effects of the three phosphodiesterase-5 inhibitors approved for the treatment of erectile dysfunction. Circulation 2004; 110: 3149–3155.

    Article  PubMed  Google Scholar 

  40. DeBusk R et al. Management of sexual dysfunction in patients with cardiovascular disease: recommendations of the Princeton Consensus Panel. Am J Cardiol 2000; 86: 175–181.

    Article  CAS  PubMed  Google Scholar 

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Kloner, R., Padma-Nathan, H. Erectile dysfunction in patients with coronary artery disease. Int J Impot Res 17, 209–215 (2005). https://doi.org/10.1038/sj.ijir.3901309

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