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Why do patients with heart failure suffer from erectile dysfunction? A critical review and suggestions on how to approach this problem

Abstract

Chronic heart failure (HF) is an increasingly common cardiovascular disorder. The goal of health-care providers is to optimize quality of life in this population, including sexual health. Up to 75% of patients with HF report erectile dysfunction (ED). As HF is a condition with distinct physiologic sequelae, some unique organic and psychological factors contributing to ED in this patient population have been identified, along with risk factors common to the development of coronary artery disease, HF and ED. This review describes contributing factors to ED in the setting of HF and highlights treatment considerations for this distinct patient population.

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References

  1. Lue TF . Erectile dysfunction. N Engl J Med 2000; 342: 1802–1813.

    CAS  Article  PubMed  Google Scholar 

  2. Petrie M, Murray JM . Changes in notions about heart failure. Lancet 2001; 358: 432–434.

    CAS  PubMed  Google Scholar 

  3. Jaarsma T, Dracup K, Walden J, Stevenson LW . Sexual function in patients with advanced heart failure. Heart Lung 1996; 25: 262–270.

    CAS  PubMed  Google Scholar 

  4. Stanek EJ et al. Preferences for treatment outcomes in patients with heart failure: symptoms versus survival. J Card Failure 2000; 6: 225–232.

    CAS  Google Scholar 

  5. Grady KL et al. Symptom distress in cardiac transplantation. Heart Lung 1992; 21: 434–439.

    CAS  PubMed  Google Scholar 

  6. Wassertheil-Smoller S et al. Effect of antihypertensives on sexual function and quality of life: the TAMI study. Ann Intern Med 1991; 114: 613–620.

    CAS  PubMed  Google Scholar 

  7. Kaiser FE et al. Impotence and aging: clinical and hormonal factors. J Am Geriatr Soc 1988; 36: 511–519.

    CAS  PubMed  Google Scholar 

  8. Seftel AD, Sun P, Swindle R . The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol 2004; 171: 2341–2345.

    PubMed  Google Scholar 

  9. Shabsigh R, Fishman IJ, Schum C, Dunn JK . Cigarette smoking and other vascular risk factors in vasculogenic impotence. Urology 1991; 38: 227–232.

    CAS  PubMed  Google Scholar 

  10. Derby CA et al. Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk? Urology 2000; 56: 302–306.

    CAS  PubMed  Google Scholar 

  11. Solomon H, Man JW, Wierzbicki AS, Jackson G . Relation of erectile dysfunction to angiographic coronary artery disease. Am J Cardiol 2003; 91: 230–231.

    PubMed  Google Scholar 

  12. Montorsi F et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol 2003; 44: 360–365.

    PubMed  Google Scholar 

  13. Wabrek AJ, Burchell C . Male sexual dysfunction associated with coronary artery disease. Arch Sexual Behav 1980; 9: 69–75.

    CAS  Google Scholar 

  14. Diokno AC, Brown MB, Herzog R . Sexual function in elderly. Arch Intern Med 1990; 150: 197–200.

    CAS  PubMed  Google Scholar 

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

    CAS  Google Scholar 

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

    PubMed  Google Scholar 

  17. Greenstein A et al. Does severity of ischemic coronary disease correlate with erectile dysfunction? Int J Impot Res 1997; 9: 123–126.

    CAS  Article  PubMed  Google Scholar 

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

    Google Scholar 

  19. Solomon H et al. Erectile dysfunction: cardiovascular risk and the role of cardiologist. Int J Clin Pract 2003; 57: 96–99.

    CAS  PubMed  Google Scholar 

  20. Larson JL, McNaughton MW, Kennedy JW, Mansfield LW . Heart rate and blood pressure responses to sexual activity and a stairclimbing test. Heart Lung 1980; 9: 1025–1030.

    CAS  PubMed  Google Scholar 

  21. Meiler SEL et al. An analysis of the determinants of exercise performance in congestive heart failure. Am Heart J 1987; 113: 1207–1217.

    CAS  PubMed  Google Scholar 

  22. Seidman SN, Roose SP . The relationship between depression and erectile dysfunction. Curr Psychiatry Rep 2000; 2: 201–205.

    CAS  PubMed  Google Scholar 

  23. Cleland JG, Wang M . Depression and heart failure: not yet a target for therapy? Eur Heart J 1999; 20: 1529–1531.

    CAS  PubMed  Google Scholar 

  24. Majani G et al. Relationship between physiological profile and cardiological variables in chronic heart failure: the role of pt subjectivity. Eur Heart J 1999; 20: 1579–1586.

    CAS  PubMed  Google Scholar 

  25. Golstein I . The mutually reinforcing triad of depressive symptoms, cardiovascular disease, and erectile dysfunction. Am J Cardiol 2000; 86: 41F–45F.

    Google Scholar 

  26. Friedman S . Cardiac disease, anxiety and sexual functioning. Am J Cardiol 2000; 86: 46f–50f.

    CAS  PubMed  Google Scholar 

  27. Virag R, Bouilly P, Frydman D . Is impotence an arterial disorder? A study of arterial risk factors in 440 impotent men. Lancet 1985; 1: 181–184.

    CAS  PubMed  Google Scholar 

  28. Drexler H et al. Endothelial function in chronic congestive heart failure. Am J Cardiol 1992; 69: 1596–1601.

    CAS  PubMed  Google Scholar 

  29. Elsner D, Muntze A, Kromer EP, Riegger GA . Systemic vasoconstriction induced by inhibition of nitric oxide synthesis is attenuated in conscious dogs with heart failure. Cardiovasc Res 1991; 25: 438–440.

    CAS  PubMed  Google Scholar 

  30. Kubo SH et al. Lack of contribution of nitric oxide of basal vasomotor tone in heart failure. Am J Cardiol 1994; 74: 1133–1136.

    CAS  PubMed  Google Scholar 

  31. Habib F et al. Enhanced basal nitric oxide production in heart failure: another failed counterregulatory vasodilator mechanism? Lancet 1994; 344: 371–373.

    CAS  PubMed  Google Scholar 

  32. Winlaw DS et al. Increased nitric oxide production in heart failure. Lancet 1994; 344: 373–374.

    CAS  PubMed  Google Scholar 

  33. Maguire SM et al. Abnormal vascular responses in human chronic cardiac failure are both endothelium dependent and endothelium independent. Heart 1998; 80: 141–145.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Smith CJ et al. Reduced gene expression in vascular endothelium NO synthase and cycloxygenase-1 in heart failure. Circ Res 1996; 78: 58–64.

    CAS  PubMed  Google Scholar 

  35. Ludmer P et al. Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries. N Eng J Med 1986; 315: 1046–1051.

    CAS  Google Scholar 

  36. Bossaller C et al. Impaired muscarinic endothelium-dependent relaxation and cyclic guanosine-5′-monophosphate formation in atherosclerotic human coronary artery and rabbit aorta. J Clin Invest 1987; 79: 170–182.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Chester AH et al. Low basal and stimulated release of nitric oxide in atherosclerotic epicardial coronary arteries. Lancet 1990; 336: 897–900.

    CAS  PubMed  Google Scholar 

  38. Nabel EG, Selwyn AP, Ganz P . Large coronary arteries in humans are responsive to changing blood flow: an endothelium-dependent mechanism that fails in patients with atherosclerosis. J Am Coll Cardiol 1990; 16: 349–356.

    CAS  PubMed  Google Scholar 

  39. Stewart DJ, Pohl U, Bassange E . Free radicals inhibits endothelium-dependent dilation in the coronary resistance bed. Am J Physiol 1988; 255: H765–H769.

    CAS  PubMed  Google Scholar 

  40. Boger RH, Bode-Boger SM, Frolisch JC . The L-arginine–nitric oxide pathway: role in atherosclerosis and therapeutic implications. Atherosclerosis 1996; 127: 1–11.

    CAS  PubMed  Google Scholar 

  41. McMurray JJ et al. Plasma endothelin in chronic heart failure. Circulation 1992; 85: 1374–1379.

    CAS  PubMed  Google Scholar 

  42. Wei CM et al. Endothelin in human congestive heart failure. Circulation 1994; 89: 1580–1586.

    CAS  PubMed  Google Scholar 

  43. Busse R, Hecker M, Fleming I . Control of nitric oxide and prostacyclin synthesis in endothelial cells. Arzneimittelforschung 1994; 44: 392–396.

    CAS  PubMed  Google Scholar 

  44. Andersson KE, Wagner G . Physiology of penile erection. Physiol Rev 1997; 75: 191–236.

    Google Scholar 

  45. Becker AJ et al. Systemic and cavernosal plasma levels of endothelin (1–21) during different penile conditions in healthy males and patients with erectile dysfunction. World J Urol 2001; 19: 371–376.

    CAS  PubMed  Google Scholar 

  46. Holmquist F, Andersson KE, Hedlund H . Actions of endothelin on isolated corpus cavernosum from rabbit and man. Acta Physiol Scand 1990; 139: 113–122.

    CAS  PubMed  Google Scholar 

  47. Christ GJ, Lerner SE, Kim DC, Melman A . Endothelin-1 as a putative modulator of erectile dysfunction I: characteristics of contraction of isolated corporal tissue strips. J Urol 1995; 153: 1998–2003.

    CAS  PubMed  Google Scholar 

  48. Kim DC, Gondre CM, Christ GJ . Endothelin-1-induced modulation of contractile responses elicited by an alpha 1-adrenergic agonist on human corpus cavernosum smooth cells. Int J Impot Res 1996; 8: 17–24.

    CAS  PubMed  Google Scholar 

  49. Zhao W, Christ GJ . Endothelin-1 as putative modulator of erectile dysfunction II: calcium mobilization in cultured human corporal smooth muscle cells. J Urol 1995; 154: 1571–1579.

    CAS  PubMed  Google Scholar 

  50. Nakamura M et al. Endothelium-dependent vasodilation is not selectively impaired in patients with chronic heart failure secondary to valvular heart disease and congenital heart disease. Eur Heart J 1996; 17: 875–881.

    Google Scholar 

  51. Longhurst J, Capone RJ, Zelis R . Evaluation of skeletal muscle capillary basement membrane thickness in congestive heart failure. Chest 1975; 67: 195–198.

    CAS  PubMed  Google Scholar 

  52. Wrobleski H et al. Evidence of increased microvascular resistance and arteriolar hyalinosis in skin in congestive heart failure secondary to dilated cardiomyopathy. Am J Cardiol 1992; 69: 769–774.

    Google Scholar 

  53. Tsutamoto T et al. Possibility of down regulation of atrial natriuretic factor receptor coupled to guanylate cyclase in peripheral vascular beds of patients with chronic severe heart failure. Circulation 1993; 87: 70–75.

    CAS  PubMed  Google Scholar 

  54. Gupta S et al. A possible mechanism for alteration of human erectile function by digoxin: Inhibition of corpus cavernosum sodium/potassium adenosine triphosphate activity. J Urol 1998; 159: 1529–1536.

    CAS  PubMed  Google Scholar 

  55. Stoffer SS, Hynes KM, Jiang NS, Ryan RJ . Digoxin and abnormal serum hormone levels. JAMA 1973; 225: 1643–1644.

    CAS  PubMed  Google Scholar 

  56. Neri A et al. The effect of long-term administration of digoxin on plasma androgens and sexual dysfunction. J Sex Marital Ther 1987; 13: 58–63.

    CAS  PubMed  Google Scholar 

  57. Kley HK, Muller A, Pecrenboon H, Kruskemper H . Digoxin does not alter plasma steroid level in healthy men. Clin Pharmacol Ther 1982; 32: 12–17.

    CAS  PubMed  Google Scholar 

  58. Kley HK et al. No effect of digitalis on sex and adrenal hormones in healthy subjects and in patients with congestive heart failure. Klin Wochenschr 1984; 62: 65–73.

    CAS  PubMed  Google Scholar 

  59. Bellmann O, Ochs HR, Knuchel M, Greenblatt DJ . Evaluation of hypothalamus-pituitary effects of digoxin. J Clin Pharmacol 1984; 24: 474–479.

    CAS  PubMed  Google Scholar 

  60. Gupta S et al. Possible role of Na-K-Atpase in the regulation of human corpus cavernosum smooth muscle contractility by nitric oxide. Br J Pharmacol 1995; 116: 2201–2206.

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Dusing R . Sexual dysfunction in male patients with hypertension: influence of antihypertensive drugs. Drugs 2005; 65: 773–786.

    PubMed  Google Scholar 

  62. Grimm HR, Grandits GA, Svendsen K, TOMHS Research Group. Incidence and disappearance of erectile problems in men treated with for stage I hypertension: the treatment of mild hypertension study (TOMHS). Eur Urol 1996; 30 (Suppl 2): 26.

    Google Scholar 

  63. Frazen D et al. Effects of beta-blockers on sexual performance in men with coronary heart disease. A prospective randomized and double blinded study. Int J Impot Res 2001; 13: 348–351.

    Google Scholar 

  64. Silvestri A et al. Report of erectile dysfunction after therapy with beta blockers is related to patient knowledge of the side effects and is reversed by placebo. Eur Heart J 2003; 24: 1928–1932.

    CAS  PubMed  Google Scholar 

  65. Fogari R et al. Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. Am J Hypertens 2001; 14: 27–31.

    CAS  PubMed  Google Scholar 

  66. Neil-Dwyer G, Bartlett J, McAinish J, Cruickshank JM . Beta blockers and the blood–brain barrier. Br J Clin Pharmacol 1981; 11: 549–553.

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Buffum J . Pharmosexology update: prescription drugs and sexual function. J Psychoactive Drugs 1986; 18: 97–106.

    CAS  PubMed  Google Scholar 

  68. Scharf M, Mayleben DW . Comparative effects of prazosin and hydrochlorothiazide on sexual function in hypertensive men. Am J Med 1989; 86: 110–112.

    CAS  PubMed  Google Scholar 

  69. Croog SH et al. Sexual symptoms in hypertensive patients. Arch Intern Med 1988; 148: 788–794.

    CAS  PubMed  Google Scholar 

  70. Menard J . The 45 year story of the development of an anti-aldosterone more specific than spironolactone. Mol Cell Endocrinol 2004; 217: 45–52.

    CAS  PubMed  Google Scholar 

  71. Croog SH, Levine S, Testa MA, Sudilovsky A . The effects on antihypertensive therapy on quality of life. New Engl J Med 1986; 314: 1657–1664.

    CAS  PubMed  Google Scholar 

  72. DiBianco R . A large scale trial of captopril for mild to moderate heart failure in the primary care setting. Clin Cardiol 1991; 14: 676–682.

    CAS  PubMed  Google Scholar 

  73. Yamamoto S et al. The effects of replacing dihydropyridine calcium-channel blockers with angiotensin II receptor blocker on the quality of life in hypertensive patients. Blood Pressure Suppl 2003; 12: 22–28.

    Google Scholar 

  74. Fogari R et al. Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. Am J Hypertens 2001; 14: 27–31.

    CAS  PubMed  Google Scholar 

  75. Dusing R . Effect of the angiotensin II antagonist valsartan on sexual function in hypertensive men. Blood Press Suppl 2003; 2: 29–34.

    CAS  PubMed  Google Scholar 

  76. Chen HM, Chao YF . Change in quality of life in patients with permanent cardiac pacemakers: a six-month follow-up study. J Nurs Res 2002; 10: 143–150.

    PubMed  Google Scholar 

  77. Stern ME, Pascale L, Ackerman A . Life adjustment postmyocardial infarction. Arch Intern Med 1977; 137: 1680–1684.

    CAS  PubMed  Google Scholar 

  78. Johnston BL, Cantwell JD, Watt EW, Fletcher GF . Sexual activity in exercising patients after myocardial infarction and revascularization. Heart Lung 1978; 7: 1026–1031.

    CAS  PubMed  Google Scholar 

  79. Bloch A, Maeder J, Haisley J . Sexual problems after myocardial infarction. Am Heart J 1975; 90: 536–537.

    CAS  PubMed  Google Scholar 

  80. Papadapoulos C, Beaumont C, Shelley SI, Larrimore P . Myocardial infarction and sexual activity of the female patient. Arch Intern Med 1983; 143: 1528–1530.

    Google Scholar 

  81. Drory Y, Kravitz S, Weingarten M . Comparison of sexual activity of women and men after a first acute myocardial infarction. Am J Cardiol 2000; 85: 1283–1287.

    CAS  PubMed  Google Scholar 

  82. Langelluddecke P et al. A prospective evaluation of the psychosocial effects of coronary artery bypasses surgery. J Psychosom Res 1989; 33: 37–45.

    Google Scholar 

  83. Mayou R . The psychiatric and social consequences of coronary artery surgery. J Psychosom Res 1986; 30: 255–271.

    CAS  PubMed  Google Scholar 

  84. Papadopoulos C et al. Sexual activity after coronary bypass. Chest 1986; 90: 681–685.

    CAS  PubMed  Google Scholar 

  85. Mulligan T, Sheehan H, Hanrahan J . Sexual function after heart transplant. J Heart Lung Transplant 1991; 10: 125–128.

    CAS  PubMed  Google Scholar 

  86. Hunt SA et al. ACC/AHA2005 guideline update for the diagnosis and management of chronic heart failure in the adult. www.acc.org.

  87. Boolell M, Gepi-Attee S, Gingell JC, Allen MJ . Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol 1996; 78: 257–261.

    CAS  PubMed  Google Scholar 

  88. Fink HA et al. Sildenafil for male erectile dysfunction. A systematic review and meta-analysis. Arch Intern Med 2002; 162: 1349–1360.

    CAS  PubMed  Google Scholar 

  89. Goldstein I et al. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med 1998; 338: 1397–1414.

    CAS  PubMed  Google Scholar 

  90. Porst H et al. The efficacy and tolerability of vardenafil, a new, oral, selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial. Int J Impot Res 2001; 13: 192–199.

    CAS  PubMed  Google Scholar 

  91. Klotz T et al. Vardenafil increases penile rigidity and tumescence in erectile dysfunction patients: a Rigiscan and pharmacokinetic study. World J Urol 2001; 19: 32–39.

    CAS  PubMed  Google Scholar 

  92. Hellstrom WJ et al. Vardenafil Study Group. Sustained efficacy and tolerability of vardenafil, a highly potent selective phosphodiesterase type 5 inhibitor, in men with erectile dysfunction: results of a randomized, double blind, 26-week placebo-controlled pivotal trial. Urology 2003; 61 (Suppl 1): 8–14.

    PubMed  Google Scholar 

  93. Porst H, Padma-Nathan H, Giuliano F, Anglin G . Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 h after dosing: a randomized controlled trial. Urology 2003; 62: 121–125.

    PubMed  Google Scholar 

  94. Porst H . IC351 (tadalafil, Cialis): update on clinical experience. Int J Impot Res 2002; 14 (Suppl 1): S57–S64.

    PubMed  Google Scholar 

  95. Kloner RA . Cardiovascular effects of the 3 phosphodiesterase-5 inhibitors approved for the treatment of erectile dysfunction. Circulation 2004; 110: 3149–3155.

    PubMed  Google Scholar 

  96. Cheitlin MD et al. ACC/AHA expert consensus document use on sildenafil (Viagra) in patients with cardiovascular disease. American College of Cardiology/American Heart Association. J Am Coll Cardiol 1999; 33: 273–282.

    CAS  PubMed  Google Scholar 

  97. Katz SD et al. Efficacy and safety of sildenafil citrate in men with erectile dysfunction and chronic heart failure. Am J Cardiol 2005; 95: 36–42.

    CAS  PubMed  Google Scholar 

  98. Bocchi EA et al. Sildenafil effects on exercise, neurohormonal activation, and erectile dysfunction in congestive heart failure. Circulation 2002; 106: 1097–1103.

    PubMed  Google Scholar 

  99. Webster LJ, Michelakis ED, Davis T, Archer SL . Use of sildenafil for safe improvement of erectile dysfunction and quality of life in men with New York Heart Association classes II and III congestive heart failure: a prospective, placebo-controlled, double-blind crossover trial. Arch Intern Med 2004; 164: 514–520.

    CAS  PubMed  Google Scholar 

  100. Valji K, Bookstein JJ . Transluminal angioplasty in the treatment of arteriogenic impotence. Cardiovasc Interven Radiol 1988; 11: 245–252.

    CAS  Google Scholar 

  101. Urigo F et al. Role of arteriography and percutaneous transluminal angioplasty in the diagnosis and treatment of arterilal vasculogenic impotence. Radiol Med (Torino) 1994; 88: 86–92.

    CAS  Google Scholar 

  102. Angelini P, Fighali S . Early experience with balloon angioplasty of internal iliac arteries for vasculogenic impotence. Cath Cardiovasc Diagn 1987; 13: 107–110.

    CAS  Google Scholar 

  103. Mielecki T, Marciniak R, Drelichowski S, Kukula M . Results of the treatment of vascular-induced impotence using PTA. Rontgenblatter 1990; 43: 435–438.

    CAS  PubMed  Google Scholar 

  104. Manning M et al. Long-term follow up and selection criteria for penile revascularization in erectile failure. J Urol 1998; 160: 1680–1684.

    CAS  PubMed  Google Scholar 

  105. Zumbe J et al. Indications for penile revascularization and long-term results. Andrologia (Suppl) 1999; 31: 83–87.

    Google Scholar 

  106. Michal V, Kramar R, Pospichal J, Heijhal L . Arterial epigastricocavernous anastomosis for the treatment of sexual impotence. World J Surg 1977; 1: 515–520.

    CAS  PubMed  Google Scholar 

  107. Goldstein I . Arterial revascularization procedures. Semin Urol 1986; 4: 252–258.

    CAS  PubMed  Google Scholar 

  108. Virag W et al. Investigation and surgical treatment of vasculogenic impotencey. J Mal Vasc 1980; 5: 205–209.

    CAS  PubMed  Google Scholar 

  109. Hauri D . A new operative technique in vasculogenic erectile impotence. World J Urol 1986; 4: 237–249.

    Google Scholar 

  110. Furlow WL, Fisher J, Knoll LD . Penile revascularization: experience with deep dorsal vein arterialization: The Furlow–Fisher modification with 27 patients. In: Proceedings of the Third Biennial World Meeting on Impotence. International Society of Impotence Research: Boston, MA, 1988.

    Google Scholar 

  111. Kawanishi Y et al. Penile revascularization surgery for arteriogenic erectile dysfunction: the long-term efficacy rate calculated by survival analysis. BJU Int 2004; 94: 361–368.

    PubMed  Google Scholar 

  112. Herman JB et al. Fluoxetine induced sexual dysfunction. J Clin Psychiatry 1990; 51: 25–27.

    CAS  PubMed  Google Scholar 

  113. Kim SE, Seo KK . Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: a double blind, placebo controlled study. J Urol 1998; 159: 425–427.

    CAS  PubMed  Google Scholar 

  114. Bohlen JG, Held JP, Sanderson MO, Patterson RP . Heart rate, rate–pressure product, and oxygen uptake during four sexual activities. Arch Intern Med 1984; 144: 1745–1748.

    CAS  PubMed  Google Scholar 

  115. Namec ED, Mansfield L, Kennedy JW . Heart rate and blood pressure responses during sexual activity in normal males. Am Heart J 1976; 92: 274–277.

    Google Scholar 

  116. McCann ME . Sexual healing after heart attack. Am J Nurs 1989; 89: 1133–1138.

    CAS  PubMed  Google Scholar 

  117. Westlake C, Dracup K, Walden J, Fonarow G . Sexuality of patients with advanced heart failure and their spouses or partners. J Heart Lung Transplant 1999; 18: 1133–1138.

    CAS  PubMed  Google Scholar 

  118. Bloch A, Maeder J, Haissly J . Sexual problems after myocardial infarction. Am Heart J 1975; 90: 536–537.

    CAS  PubMed  Google Scholar 

  119. Hellerstein HK, Friedman EH . Sexual activity and the post coronary patient. Arch Intern Med 1970; 125: 987–999.

    CAS  PubMed  Google Scholar 

  120. Braceland FJ . The coronary spectrum: psychiatric aspects. J Rehab 1966; 32: 53–55.

    CAS  PubMed  Google Scholar 

  121. Green AW . Sexual activity and the post myocardial infarction patient. Am Heart J 1975; 89: 246–252.

    CAS  PubMed  Google Scholar 

  122. Bilodeau CB, Hackett TP . Issues raised in a group setting by patients recovering from myocardial infarction. Am J Psychiatry 1971; 128: 73–78.

    CAS  PubMed  Google Scholar 

  123. Chitaley K, Webb RC, Mills T . Rho A/Rho-kinase: a novel player in the regulation of penile erection. Int J Impot Res 2001; 13: 67–72.

    CAS  PubMed  Google Scholar 

  124. Lin CS et al. Intracavernosal injection of vascular endothelial growth factor induces nitric oxide synthase isoforms. BJU Int 2002; 89: 955–960.

    CAS  PubMed  Google Scholar 

  125. Bivalacqua TJ et al. Gene therapy techniques for the delivery of endothelial nitric oxide synthase to the corpora cavernosa for erectile dysfunction. Methods Mol Biol 2004; 279: 173–185.

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  127. Bai Q et al. Prevalence and risk factors of erectile dysfunction in three cities of China: a community based study. Asian J Androl 2004; 6: 343–348.

    PubMed  Google Scholar 

  128. Safarinejad MR . Prevalence and risk factors for erectile dysfunction in a population-based study in Iran. Int J Impot Res 2003; 15: 246–252.

    CAS  PubMed  Google Scholar 

  129. Chew KK et al. Erectile dysfunction in general medicine practice: prevalence and clinical correlates. Int J Impot Res 2000; 12: 41–45.

    CAS  PubMed  Google Scholar 

  130. Bacon CG et al. Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med 2003; 139: 161–168.

    PubMed  Google Scholar 

  131. Morillo LE et al. Prevalence of erectile dysfunction in Columbia, Ecuador, and Venenzuela: a population-based study (DENSA). Int J Impot Res 2002; 14 (Suppl 2): S10–S18.

    PubMed  Google Scholar 

  132. Moreira Jr ED, Bestane WJ, Bartolo EB, Fittipaldi JA . Prevalence and determination of erectile dysfunction in Santos, southeastern Brazil. Sau Paulo Med J 2002; 120: 49–54.

    Google Scholar 

  133. Shiri R et al. Prevalence and severity of erectile of erectile dysfunction in 50–75-year-old Finnish men. J Urol 2003; 170: 2342–2344.

    PubMed  Google Scholar 

  134. McCulloch DK et al. The prevalence of diabetic impotence. Diabetologia 1980; 18: 279–283.

    CAS  PubMed  Google Scholar 

  135. Klein R et al. Prevalence of self-reported erectile dysfunction in people with long-term IDDM. Diabetes Care 1996; 19: 135–141.

    CAS  PubMed  Google Scholar 

  136. Yamasaki H et al. Prevalence and risk factors of erectile dysfunction in Japanese men with type 2 diabetes. Diabetes Res Clin Pract 2004; 66 (Suppl 1): S173–S177.

    PubMed  Google Scholar 

  137. Alonso Sandoica E et al. Impotence in diabetic patients: detection of prevalence and social-health implications. Aten Primaria 1997; 20: 435–439.

    CAS  PubMed  Google Scholar 

  138. Siu SC et al. Prevalence of and risk factors for erectile dysfunction in Hong Kong diabetic patients. Diabet Med 2001; 18: 732–738.

    CAS  PubMed  Google Scholar 

  139. Burchardt M et al. Hypertension is associated with severe erectile dysfunction. J Urol 2000; 164: 1188–1191.

    CAS  PubMed  Google Scholar 

  140. Jensen J et al. The prevalence and etiology of impotence in 101 male hypertensive outpatients. Am J Hypertens 1999; 12: 271–275.

    CAS  PubMed  Google Scholar 

  141. Cuellar de Leon AJ et al. Prevalence of erectile dysfunction in patients with hypertension. Med Clin (Barcelona) 2002; 119: 521–526.

    Google Scholar 

  142. Esposito K, Giugliano D . Obesity, the metabolic syndrome, and sexual dysfunction. Int J Impot Res 2005; 17: 391–398.

    CAS  PubMed  Google Scholar 

  143. Esposito K et al. Effect of lifestyle changes on erectile dysfunction in obese men. JAMA 2004; 291: 2978–2984.

    CAS  PubMed  Google Scholar 

  144. Gunduz MI, Gumus BH, Sekuri C . Relationship between metabolic syndrome and erectile dysfunction. Relationship between metabolic syndrome and erectile dysfunction. Asian J Androl 2004; 6: 355–358.

    CAS  PubMed  Google Scholar 

  145. Nikoobakht M, Nasseh H, Pourkasmaee M . The relationship between lipid profile and erectile dysfunction. Int J Impot Res 2005 [Jun Epub in press].

  146. Wei M et al. Total cholesterol and high density lipioprotein cholesterol as important predictors of erectile dysfunction. Am J Epidemiol 1994; 140: 930–937.

    CAS  PubMed  Google Scholar 

  147. Saltzman EA, Guay AT, Jacobson J . Improvement in erectile function in men with organic erectile dysfunction by correction of elevated cholesterol levels: a clinical observation. J Urol 2004; 172: 255–258.

    PubMed  Google Scholar 

  148. Araujo AB et al. The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging study. Psychosom Med 1998; 60: 458–465.

    CAS  PubMed  Google Scholar 

  149. Gades NM et al. Association between smoking and erectile dysfunction: a population-based study. Am J Epidemiol 2005; 161: 346–351.

    PubMed  Google Scholar 

  150. Mannino DM, Klevens RM, Flanders WD . Cigarette smoking: an independent risk factor for impotence? Am J Epidemiol 1994; 140: 1003–1008.

    CAS  PubMed  Google Scholar 

  151. Mirone V et al. Cigarette smoking as a risk factor for erectile dysfunction: results from an Italian epidemiological study. Eur Urol 2002; 41: 294–297.

    PubMed  Google Scholar 

  152. Derby CA, Barbour MM, Hume AL, McKinlay JB . Drug therapy and prevalence of erectile dysfunction in the Massachusetts Male Aging Study cohort. Pharmacotherapy 2001; 21: 676–683.

    CAS  PubMed  Google Scholar 

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Correspondence to E R Schwarz.

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Rastogi, S., Rodriguez, J., Kapur, V. et al. Why do patients with heart failure suffer from erectile dysfunction? A critical review and suggestions on how to approach this problem. Int J Impot Res 17, S25–S36 (2005). https://doi.org/10.1038/sj.ijir.3901426

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  • DOI: https://doi.org/10.1038/sj.ijir.3901426

Keywords

  • erectile dysfunction
  • heart failure
  • phosphodiesterase inhibitors

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