Modifying Risk Factors in the Management of Erectile Dysfunction: A Review

IntroductionPhosphodiesterase type 5 inhibitors (PDE5-Is) are first-line drugs for erectile dysfunction. Non-arteritic anterior ischemic optic neuropathy (NAION) has been linked with PDE5-I use. However, no meta-analysis or conclusive review has explored the association between NAION and PDE5-I use.AimTo investigate the association between PDE5-I use and risk of NAION.MethodsA comprehensive literature search was conducted using online databases in October 2017 to obtain studies researching the association between PDE5-I application and occurrence of NAION. Summarized unadjusted risk ratios (RRs) with 95% CIs were calculated for the strength of this association. This study was conducted in accordance to Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and registered in PROSPERO under number CRD42017080865.Main Outcome MeasuresThe strength of association between PDE5-I use and risk of NAION was assessed through pooled unadjusted RRs and 95% CIs.Results5 original articles with 6 clinical observations were included in the meta-analysis. No significant higher risk of NAION was observed after the use of PDE5-Is within a 1-month period (RR = 1.16, 95% CI = 0.98-1.39, P = .09). Subgroup analyses indicated 2 PDE5-Is were significantly related to NAION (tadalafil: RR = 2.14, 95% CI = 1.20–3.84, P = .01; sildenafil: RR = 2.25, 95% CI = 1.29–3.94, P = .004).ConclusionsAlthough we found no association between NAION and PDE5-I use, our results should be interpreted cautiously because we included only observational studies and could not control for potential confounders. Because NAION is a rare ocular disease and difficult to diagnose, this association should be confirmed in prospective comparative studies with larger samples and more rigorous designs.Liu B, Zhu L, Zhong J, et al. The Association Between Phosphodiesterase Type 5 Inhibitor Use and Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis. Sex Med 2018;6:185−192.

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“… 2 The interaction of ED with different systematic diseases such as diabetes also has been researched. 3 …”

Section: Introductionmentioning

confidence: 99%

The Association Between Phosphodiesterase Type 5 Inhibitor Use and Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis

et al. 2018

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“…Studies have also showed that modifying shared risk factors, including tobacco use, hyperlipidemia, and dietary change/weight loss/exercise in targeted patients is associated with symptomatic improvement in ED [22–26]. Therefore, patients with high burden of subclinical atherosclerosis detected by CAC would benefit from aggressive risk factor modification, potentially helping to delay or prevent the future onset of ED and overt CVD.…”

Section: Recent Studies On the Relationship Interaction And Temporamentioning

confidence: 99%

Vascular Erectile Dysfunction and Subclinical Cardiovascular Disease

Gowani

Uddin

Mirbolouk

et al. 2017

Curr Sex Health Rep

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Purpose of review We review the recent literature on the hypothesized temporal relationship between subclinical cardiovascular disease (CVD), vascular erectile dysfunction (ED), and clinical CVD. In addition, we combine emerging research with expert consensus guidelines such as The Princeton Consensus III to provide a preventive cardiologist’s perspective toward an ideal approach to evaluating and managing CVD and ED risk in patients. Recent findings Development of ED was found to occur during the progression from subclinical CVD to clinical CVD. A strong association was observed between subclinical CVD as assessed by coronary artery calcium (CAC) and carotid plaque and subsequent ED, providing evidence for the role of subclinical CVD in predicting ED. ED is also identified as a substantial independent risk factor for overt clinical CVD, and ED symptoms may precede CVD symptoms by 2–3 years. Summary Given the body of evidence on the relationship between subclinical CVD, ED, and clinical CVD we recommend that all men with vascular ED should undergo cardiovascular risk assessment. We further recommend using CAC scores for advanced risk assessment in patients at low-intermediate to intermediate risk (5–20% CVD risk), with risk driving subsequent lifestyle and pharmacologic treatment decisions.

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“…3 , 11 , 21 , 29 , 30 , 31 Additional medical treatment possibilities are scarce, although the role of non-pharmacologic lifestyle interventions in lessening the burden of ED has increasingly been recognized. 3 , 12 , 14 , 32 , 33 …”

Section: Introductionmentioning

confidence: 99%

“…Hence, there is strong evidence that frequent PA significantly improves erectile function. 3 , 11 , 12 , 31 Previous reviews have assessed the association between PA and ED, 3 , 5 , 12 , 14 , 33 but the quality and quantity of PA needed (ie, modalities, duration, intensity, and frequency 39 ) are insufficiently described, 12 , 14 although knowledge of these is essential for clinical guidance of patients with ED. 4 , 12 , 19 , 28 , 40 …”

Section: Introductionmentioning

confidence: 99%

Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies

et al. 2018

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IntroductionThe leading cause of erectile dysfunction (ED) is arterial dysfunction, with cardiovascular disease as the most common comorbidity. Therefore, ED is typically linked to a web of closely interrelated cardiovascular risk factors such as physical inactivity, obesity, hypertension, and metabolic syndrome. Physical activity (PA) has proved to be a protective factor against erectile problems, and it has been shown to improve erectile function for men affected by vascular ED. This systematic review estimated the levels of PA needed to decrease ED for men with physical inactivity, obesity, hypertension, metabolic syndrome, and/or manifest cardiovascular diseases.AimTo provide recommendations of levels of PA needed to decrease ED for men with physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases.MethodsIn accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was performed of research articles specifically investigating PA as a possible treatment of ED. The review included research on ED from physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases. All available studies from 2006 through 2016 were checked for the predetermined inclusion and exclusion criteria to analyze the levels of PA needed to decrease ED.Results10 articles met the inclusion criteria, all suggesting various levels of PA needed to decrease ED for men with relevant risk factors for ED. The results of the review provided sufficient research evidence for conclusions regarding the levels of PA necessary to decrease ED.ConclusionRecommendations of PA to decrease ED should include supervised training consisting of 40 minutes of aerobic exercise of moderate to vigorous intensity 4 times per week. Overall, weekly exercise of 160 minutes for 6 months contributes to decreasing erectile problems in men with ED caused by physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases.Gerbild H, Larsen CM, Graugaard C, Areskoug Josefsson K. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sex Med 2018;6:75–89.

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Modifying Risk Factors in the Management of Erectile Dysfunction: A Review

Cited by 71 publications

References 99 publications

The Association Between Phosphodiesterase Type 5 Inhibitor Use and Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis

The Association Between Phosphodiesterase Type 5 Inhibitor Use and Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis

Vascular Erectile Dysfunction and Subclinical Cardiovascular Disease

Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies

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