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

International Journal of Impotence Research volume 17, pages S37–S43 (2005)Cite this article

Abstract

Erectile dysfunction (ED) is increasingly considered as one manifestation of systemic vascular disease. Accordingly, ED and coronary artery disease share mutual risk factors and frequently coexist. Sexual health is an important aspect of our patients' lives, and ED is a common concern of the cardiovascular patient. Despite this, sexual function is under-addressed in the cardiac patient. Even when this topic is broached by the primary care physician or urologist, ED frequently remains untreated due to safety concerns involving cardiac disease and other comorbidities. This article describes our experience with this unique patient population, as well as our approach to building a multidisciplinary clinic designed to specifically address the important issue of ED in the cardiac patient.

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References

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

    Article  CAS  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Google Scholar 

  10. 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 

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

    Article  CAS  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. 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.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  17. 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 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. 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 

  21. 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.

    Article  CAS  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. Piha J, Kaaja R . Effects of monoxidine and metoprolol in penile circulation in hypertensive men with erectile dysfunction: results of a pilot study. Int J Impot Res 2003; 5: 287–289.

    Article  Google Scholar 

  24. Ko DT et al. Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA 2002; 288: 351–357.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  26. 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.

    Article  CAS  PubMed  Google Scholar 

  27. 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 2003; 12: 22–28.

    Article  Google Scholar 

  28. Llisterri JL et al. Sexual dysfunction in hypertensive patients treated with losartan. Am J Med Sci 2001; 321: 336–341.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  31. 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 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  36. 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.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  39. 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.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  42. Dula E, Bukofzer S, Perdok R, George M, For the Apomorphine SL Study Group. Double-blind, crossover comparison on 3 mg apomorphine SL with placebo and with 4 mg apomorphine SL in male erectile dysfunction. Eur Urol 2001; 39: 558–563.

    Article  CAS  PubMed  Google Scholar 

  43. Guay AT et al. Yohimbine treatment of organic erectile dysfunction in a dose-escalation trial. Int J Impot Res 2002; 14: 25–31.

    Article  CAS  PubMed  Google Scholar 

  44. Morgentaler A . Male impotence. Lancet 1999; 354: 1713–1718.

    Article  CAS  PubMed  Google Scholar 

  45. Wang C et al. Longterm testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab 2004; 89: 2085–2098.

    Article  CAS  PubMed  Google Scholar 

  46. Virag R et al. Intracavernous self-injection of vasoactive drugs in the treatment of impotence: 8 year experience with 615 cases. J Urol 1991; 145: 287–292.

    Article  CAS  PubMed  Google Scholar 

  47. Vaidyanathan S, Krishnan KR . Myocardial infarction associated with intra-cavernosal administration of alprostadil in a patient with spinal cord injury and paraplegia. Spinal Cord 1996; 34: 754–755.

    Article  CAS  PubMed  Google Scholar 

  48. Porst H . Transurethral alprostadil with MUSE (medicated urethral system for erection) vs intracavernous alprostadil- a comparative study in 103 patients with erectile dysfunction. Int J Impot Res 1997; 9: 187–192.

    Article  CAS  PubMed  Google Scholar 

  49. Lewis RW, Witherington R . External vacuum therapy for erectile dysfunction: use and results. World J Urol 1997; 15: 78–82.

    Article  CAS  PubMed  Google Scholar 

  50. Levine LA, Estrada CR, Morgentaler A . Mechanical reliability and safety of and patient satisfaction with the ambicor inflatable penile prosthesis: results of a 2 center study. J Urol 2001; 166: 932–937.

    Article  CAS  PubMed  Google Scholar 

  51. Carson CC, Mulcahy JJ, Govier FE, the AMS 700CX study group. Efficacy, safety and patient satisfaction outcomes of the AMS 700CX inflatable penile prosthesis: results of a longterm multicenter study. J Urol 2000; 164: 376–380.

    Article  CAS  PubMed  Google Scholar 

  52. Solomon H, Man J, Martin E, Jackson G . Role of exercise treadmill testing in the management of erectile dysfunction: a joint cardiovascular/erectile dysfunction clinic. Heart 2003; 89: 671–672.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, The University of Texas Medical Branch (UTMB), Galveston, Texas, USA

    E R Schwarz, S Rastogi, J J Rodriguez, V Kapur, N Sulemanjee, R Gupta & S Rosanio

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  1. E R Schwarz
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  2. S Rastogi
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  3. J J Rodriguez
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Correspondence to E R Schwarz.

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Schwarz, E., Rastogi, S., Rodriguez, J. et al. A multidisciplinary approach to assess erectile dysfunction in high-risk cardiovascular patients. Int J Impot Res 17 (Suppl 1), S37–S43 (2005). https://doi.org/10.1038/sj.ijir.3901427

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