Erectile dysfunction as a predictor of cardiovascular disease

As men grow older, testosterone levels fall, with a steeper decline in unbound or free testosterone compared with total testosterone concentrations. Lower testosterone levels have been associated with poorer cognitive function, and with impaired general and sexual health in aging men. Recently, lower testosterone levels have been linked with metabolic syndrome and type II diabetes, both conditions associated with cardiovascular disease, and shown to predict higher overall and cardiovascular-related mortality in middle-aged and older men. However, reverse causation has to be considered, as systemic illness may result in reduced testosterone levels. Thus, the strength of these associations and the likely direction of causation need to be carefully considered. Furthermore, these conditions may overlap, for example aging, lower testosterone levels, erectile dysfunction and cardiovascular disease are interrelated. Cross-sectional and longitudinal observational studies may be informative. However, ultimately randomized controlled trials of testosterone therapy are needed to clarify its role in the maintenance of general and sexual health in aging men. Testosterone therapy should be considered in hypogonadal men who meet rigorous criteria for the diagnosis of androgen deficiency. Additional consideration should be given to designing and testing interventions that may prevent or ameliorate the age-related decline in testosterone levels in men.

Section: Testosterone Cardiovascular Risk and Mortality In Aging Menmentioning

confidence: 99%

Are declining testosterone levels a major risk factor for ill-health in aging men?

Yeap

2008

“…Despite several methodological differences (such as cohorts, assessment of ED, definition and assessment of cardiovascular events) and the fact that ED was not an independent predictor of cardiovascular events in our series, the majority of studies and expert opinions 19,20 point in the same direction, that is, that men with ED are at higher risk for future cardiovascular events. These observations have two important clinical implications: first a cardiovascular risk profile should be obtained in men with ED and second, erectile function should be assessed in cardiovascular risk assessment.…”

Section: Discussionmentioning

confidence: 75%

Is erectile dysfunction a predictor of cardiovascular events or stroke? A prospective study using a validated questionnaire

Ponholzer

Gutjahr

Temml³

et al. 2009

Erectile dysfunction (ED) is linked to various cardiovascular risk factors and may therefore serve as a predictor of cardiovascular events. To gain further insight into this relationship, we reviewed all data regarding hospital admission for cardial or cerebral vascular disease that occurred until 2008 in a cohort of men who underwent a health investigation in 2001. Erectile function was assessed using the International Index of Erectile Function (IIEF-5) questionnaire. In total, 2506 men with a negative history of cardial or cerebral vascular disease were analysed. During the 6.5-year followup, 58 cardiovascular events (2.3%) occurred. Men without ED (IIEF-5 422; n ¼ 1636) at baseline developed a cardiovascular event in 1.9% (n ¼ 32) as compared with 2.9% ( þ 52%; n ¼ 26) in those with ED (IIEF-5 p22; n ¼ 670). In contrast to age (hazard ratio (HR): 1.6; 1.2-1.8 for every decade), hypertension (HR: 1.88; 1.1-3.1) and diabetes (HR: 2.6; 1.2-5.8), ED was not an independent risk factor for a cardiovascular event. Although men with ED were at increased risk for future cardiovascular events, ED was not an age-independent predictor of cardiovascular events in our cohort.

“…[3][4][5][6] As a result of the endothelial dysfunction that can occur with some types of ED, links between cardiovascular diseases and ED have been discovered. 7,8 ED is associated with coronary artery disease, 9 hypertension 10 and now heart failure (HF). 11 The goal of this review is to describe the prevalence of ED in HF patients, causes of ED specific to patients with HF, the cardiac risk assessment of sexual activity, the safety of PDE-5 inhibitors to treat ED in HF patients, the efficacy of PDE-5 inhibitors for ED in HF patients, the hemodynamic effects of PDE-5 inhibitors on HF, the potential mechanisms by which PDE-5 inhibitors improve HF and role of PDE-5 inhibitors in pulmonary hypertension.…”

Section: Introductionmentioning

confidence: 99%

Erectile dysfunction and heart failure: the role of phosphodiesterase type 5 inhibitors

Al-Ameri

Kloner

2009

Self Cite

The phosphodiesterase type 5 (PDE-5) inhibitors are effective in treating erectile dysfunction (ED). ED and heart failure (HF) share similar risk factors, and commonly present together. This association has led to questions ranging from the safety and efficacy of PDE-5 inhibitors in HF patients to a possible role for this class of medication to treat HF patients with or without ED. In addition to endothelial dysfunction, there are causes of ED specific to patients with HF including low exercise tolerance, depression and HF medications. Before treating HF patients with PDE-5 inhibitors, patients should be assessed for their risk of a cardiac event during sexual activity. PDE-5 inhibitors are safe and effective in treating ED in HF patients. An improvement in erectile function by PDE-5 inhibitors was associated with an improvement in quality of life and reduction in depression. Several studies demonstrated the effect of PDE-5 inhibitors on HF per se. PDE-5 inhibitors improved endothelial dysfunction, increased exercise tolerance, decreased pulmonary vascular resistance and pulmonary artery pressure, and increased cardiac index. Several mechanisms whereby PDE-5 inhibitors improve HF have been proposed. PDE-5 inhibitors already have a role in treating primary pulmonary hypertension; however additional studies are needed to determine if they will become a standard therapy for HF patients.