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Erectile Dysfunction in the Cardiac Patient: How Common and Should We Treat?

2003; Lippincott Williams & Wilkins; Volume: 170; Issue: 2S Linguagem: Inglês

10.1097/01.ju.0000075055.34506.59

1527-3792

Robert A. Kloner, Stephanie Mullin, Thomas Shook, Ray Matthews, Guy S. Mayeda, Steve Burstein, Harry Peled, Charles Pollick, RANJI CHOUDHARY, Raymond C. Rosen, Harin Padma-Nathan,

Hormonal and reproductive studies

No AccessJournal of UrologyArticles1 Aug 2003Erectile Dysfunction in the Cardiac Patient: How Common and Should We Treat? ROBERT A. KLONER, STEPHANIE H. MULLIN, THOMAS SHOOK, RAY MATTHEWS, GUY MAYEDA, STEVE BURSTEIN, HARRY PELED, CHARLES POLLICK, RANJI CHOUDHARY, RAYMOND ROSEN, and HARIN PADMA-NATHAN ROBERT A. KLONERROBERT A. KLONER , STEPHANIE H. MULLINSTEPHANIE H. MULLIN , THOMAS SHOOKTHOMAS SHOOK , RAY MATTHEWSRAY MATTHEWS , GUY MAYEDAGUY MAYEDA , STEVE BURSTEINSTEVE BURSTEIN , HARRY PELEDHARRY PELED , CHARLES POLLICKCHARLES POLLICK , RANJI CHOUDHARYRANJI CHOUDHARY , RAYMOND ROSENRAYMOND ROSEN , and HARIN PADMA-NATHANHARIN PADMA-NATHAN View All Author Informationhttps://doi.org/10.1097/01.ju.0000075055.34506.59AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Risk factors for erectile dysfunction (ED) (hypertension, diabetes, smoking, lipid abnormality) are also risk factors for coronary artery disease. However, most cardiologists do not routinely ask about ED and patients often are reluctant or embarrassed to discuss it. We determined how common ED was in a group of patients with chronic stable coronary artery disease. Materials and Methods: We administered the validated Sexual Health Inventory for Men (SHIM) 5-item questionnaire, based on the International Index of Erectile Function questionnaire, to 76 men with chronic stable coronary artery disease during routine outpatient cardiology visits. Most of these men had not previously discussed ED with their cardiologist. Results: The mean patient age was 64 years (range 40 to 82). The questionnaire took about 5 minutes to complete. Of the patients 47% were on beta blockers, 92% statins, 28% diuretics. SHIM score was 21 or less in 53 men (70%), which is indicative of ED. Of the patients 75% had some difficulty achieving erections (question 2) and 67% had some difficulty maintaining an erection after penetration (question 3). The questionnaire reflected successful sildenafil treatment in 4 patients (SHIM scores 23 to 25). If these 4 men are included as having had ED then 57 of 76 (75%) had ED or recent history of ED. Conclusions: ED is extremely common in men with chronic coronary artery disease (affecting approximately 75%) yet most cardiologists do not ask about it. The SHIM is a useful, quick and inexpensive tool for discussion and diagnosis of ED in this population. Although it is well established that cardiovascular risk factors are associated with erectile dysfunction, once it is present there is mixed information on whether treating the risk factors will treat the ED. Problems appear to be that lifestyle modification in midlife may simply be too late to effect a change, and some antihypertensive and lipid lowering drugs may actually exacerbate ED. Oral therapy for ED, namely the PDE5 inhibitors, is effective and safe in most cardiac and hypertensive patients. Organic nitrates such as nitroglycerin remain a contraindication to the concomitant use of these drugs. 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Google Scholar 20 : Pharmacodynamic interactions between tadalafil and nitrates. J Am Coll Cardiol2002; 39: 291A. Google Scholar 21 : Overview of the cardiovascular effects of tadalafil.. Eur Heat J2002; 4: H32. Google Scholar From the Heart Institute, Good Samaritan Hospital (RAK), Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles Cardiology Associates (SHM, TS, RM, GM, SB, HP, CP, RC), Los Angeles and Male Clinic (HP-N), Beverly Hills and Los Angeles, California, and University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School (RR), Piscataway, New Jersey© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byMONTAGUE D, JAROW J, BRODERICK G, DMOCHOWSKI R, HEATON J, LUE T, MILBANK A, NEHRA A and SHARLIP I (2018) CHAPTER 1: THE MANAGEMENT OF ERECTILE DYSFUNCTION: AN AUA UPDATEJournal of Urology, VOL. 174, NO. 1, (230-239), Online publication date: 1-Jul-2005. Volume 170Issue 2SAugust 2003Page: S46-S50 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordsdiabetes mellituscoronary arteriosclerosispenile erectionhyperlipidemiahypertensionMetricsAuthor Information ROBERT A. KLONER More articles by this author STEPHANIE H. MULLIN More articles by this author THOMAS SHOOK More articles by this author RAY MATTHEWS More articles by this author GUY MAYEDA More articles by this author STEVE BURSTEIN More articles by this author HARRY PELED More articles by this author CHARLES POLLICK More articles by this author RANJI CHOUDHARY More articles by this author RAYMOND ROSEN More articles by this author HARIN PADMA-NATHAN More articles by this author Expand All Advertisement PDF downloadLoading ...