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Erectile dysfunction and cardiac disease: Recommendations of the second princeton conference

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Abstract

Erectile dysfunction (ED) has been linked increasingly to cardiovascular risk factors and comorbidities. Considering the potential risk associated with sexual activity, guidelines were developed (Princeton I) for assessment and management of patients with varying degrees of cardiac risk. These guidelines were recently updated (Princeton II) based on new data concerning the link between ED and cardiovascular disease and the availability of additional phosphodiesterase type 5 inhibitors (vardenafil, tadalafil). Despite the need for careful risk assessment in all cases, sexual activity remains safe for the large majority of patients. However, all patients presenting with complaints of ED should be carefully assessed for the presence of cardiovascular risk factors (eg, obesity, hypertension, hyperlipidemia). Risk-factor modification, including lifestyle interventions (eg, exercise, weight loss) is strongly encouraged. Guidelines are presented for the management of acute coronary syndromes in patients taking phosphodiesterase type 5 inhibitors, including alternatives to the use of nitrates for these patients. Other drug interactions and the cardiovascular safety of testosterone replacement therapy are considered.

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References and Recommended Reading

  1. Feldman HA, Goldstein I, Hatzichristou DG, et al.: Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994, 151:54–61.

    PubMed  CAS  Google Scholar 

  2. Araujo AB, Durante R, Feldman HA, 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.

    PubMed  CAS  Google Scholar 

  3. Rosen RC, Fisher W, Eardley I, et al.: The Multinational Men’s Attitudes to Life Events and Sexuality (MALES) study: prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin 2004, 20:607–617.

    Article  PubMed  Google Scholar 

  4. Rosen RC, Wing R, Schneider S, Gendrano N 3rd:Epidemiology of erectile dysfunction: the role of medical comorbidities and lifestyle factors. Urol Clin North Am 2005, 32:403–417. A comprehensive, recent review of prevalence and risk factors for ED with special emphasis on the role of major comborbidities (eg, diabetes, heart disease, depression).

    Article  PubMed  Google Scholar 

  5. Shabsigh R, Klein LT, Seidman S, et al.: Increased incidence of depressive symptoms in men with erectile dysfunction. Urology 1998, 52:848–852.

    Article  PubMed  CAS  Google Scholar 

  6. Feldman HA, Johannes CB, Derby CA, et al.: Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts Male Aging Study. Prev Med 2000, 30:328–338.

    Article  PubMed  CAS  Google Scholar 

  7. Bacon CG, Mittleman MA, Kawachi I, 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 

  8. Fung MM, Bettencourt R, Barrett-Connor E: Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo Study. J Am Coll Cardiol 2004, 43:1405–1411.

    Article  PubMed  Google Scholar 

  9. Holden CA, McLachlan RI, Pitts M, et al.: Men in Australia, Telephone Survey (MATeS) I: a national survey of the reproductive health and concerns of middle aged and older Australian men. Lancet 2005, 366:218–224.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  11. McKinlay JB: The worldwide prevalence and epidemiology of erectile dysfunction. Int J Impot Res 2000, 12(Suppl 4):S6-S11.

    Article  PubMed  Google Scholar 

  12. Fisher W, Rosen RC, Eardley I, et al.: The multinational men’s attitudes to life events and sexuality (MALES) study phase II: understanding PDE5 inhibitor treatment seeking patterns among men with erectile dysfunction. J Sex Med 2004, 1:150–160.

    Article  PubMed  Google Scholar 

  13. DeBusk R, Drory Y, Goldstein I, et al.: Management of sexual dysfunction in patients with cardiovascular disease; the Princeton Consensus Panel. Am J Cardiol 2000, 86:175–181.

    Article  PubMed  CAS  Google Scholar 

  14. Rosen RC, Kostis JB: Overview of phosphodiesterase 5 inhibition in erectile dysfunction. Am J Cardiol 2003, 92:9M-18M.

    Article  PubMed  CAS  Google Scholar 

  15. Kloner RA, Mohan P, Norenberg C: Cardiovascular safety of vardenafil, a potent, highly selective PDE5 inhibitor in patients with erectile dysfunction: analysis of five controlled clinical trials. Pharmacol Ther 2002, 22:1371.

    Google Scholar 

  16. Kloner RA, Mitchell M, Emmick JT: Cardiovascular effects of tadalafil. Am J Cardiol 2003, 92(Suppl):37M-46M.

    Article  PubMed  CAS  Google Scholar 

  17. Esposito K, Giugliano F, Di Palo C, et al.: Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004, 291:2978–2984. The benefits of lifestyle intervention (weight loss and exercise) in the management of ED were shown in this randomized, controlled trial of men with moderate obesity and ED.

    Article  PubMed  CAS  Google Scholar 

  18. Rosen R, Friedman M, Kostis JB:Lifestyle management of erectile dysfunction: the role of cardiovascular and concomitant risk factors. Am J Cardiol 2005, 12(Suppl 2):76–79. The role of lifestyle factors in the management of ED are considered in-depth in this article.

    Article  Google Scholar 

  19. Kostis JB, Jackson G, Rosen R: Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). Am J Cardiol 2005, 96:313–321. Findings and recommendations of the Second Princeton Consensus on sexual dysfunction and cardiac risk are presented in this article. A revised algorithm for evaluation of cardiac risk associated with sexual activity is presented.

    Article  PubMed  Google Scholar 

  20. Jackson G, The second Princeton consensus on sexual dysfunction and cardiac risk: new guidelines, new challenges. Int J Clin Pract 2006, 60:127.

    Article  PubMed  Google Scholar 

  21. Ganz P: Erectile dysfunction: pathophysiological mechanisms pointing to underlying cardiovascular disease. Am J Cardiol 2005, 96:8M-12M.

    Article  PubMed  CAS  Google Scholar 

  22. Solomon H, Man JW, Jackson G: Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart 2003, 89:251–253.

    Article  PubMed  CAS  Google Scholar 

  23. Kirby M, Jackson G, Simonsen U: Endothelial dysfunction links erectile dysfunction to heart disease? Int J Clin Pract 2005, 59:225–229.

    Article  PubMed  CAS  Google Scholar 

  24. Katz S: Potential role of type 5 phosphodiesterase inhibition in the treatment of congestive heart failure. Congest Heart Fail 2003, 9:9–15. PDE5 inhibitors can be used in the treatment of other cardiovascular conditions. This article describes the results of a controlled trial of sildenafil in the treatment of congestive heart failure.

    PubMed  CAS  Google Scholar 

  25. Jackson G, Chambers J: Sildenafil for primary pulmonary hypertension: short and long-term symptomatic benefit. Int J Clin Pact 2002, 56:397–398.

    CAS  Google Scholar 

  26. Lue TF: Erectile dysfunction. N Engl J Med 2000, 342:1802–1813.

    Article  PubMed  CAS  Google Scholar 

  27. Andersson KE, Wagner G: Physiology of penile erection. Physiol Rev 1995, 75:191–236.

    PubMed  CAS  Google Scholar 

  28. Fonseca V, Jawa A: Endothelial/erectile dysfunction in diabetes and the metabolic syndrome: Implications for cardiovascular disease and patient management. Am J Cardiol 2005, 96:13M-18M.

    Article  PubMed  Google Scholar 

  29. Thompson IM, Tangen CM, Goodman PJ, et al.: Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005, 294:2996–3002. This widely-cited study demonstrated a strong link between ED and subsequent cardiovascular events among participants in the Prostate Prevention Trial.

    Article  PubMed  CAS  Google Scholar 

  30. Saigal CS, Wessells H, Pace J, et al.: Predictors and prevalence of erectile dysfunction in a racially diverse population. Arch Intern Med 2006, 166:207–212.

    Article  PubMed  Google Scholar 

  31. Grover SA, Lowensteyn I, Kaouache M, et al.: The prevalence of erectile dysfunction in the primary care setting. Arch Intern Med 2006, 166:213–219.

    Article  PubMed  Google Scholar 

  32. Montorsi P, Ravagnani PM, Galli S, et al.: The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol 2005, 96:19M-23M.

    Article  PubMed  Google Scholar 

  33. Patel MD, Katz SD: Phosphodiesterase 5 inhibition in chronic heart failure and pulmonary hypertension. Am J Cardiol 2005, 96:47M-51M.

    Article  PubMed  CAS  Google Scholar 

  34. Shabsigh R, Kaufman JM, Steidle C, Padma-Nathan H:Randomized study of testosterone gel as adjunctive therapy to Sildenafil in hypogonadal men with erectile dysfunction who do not respond to Sildenafil alone. J Urol 2004, 172:658–663.

    Article  PubMed  CAS  Google Scholar 

  35. Boyanov MA, Boneva Z, Christov VG: Testosterone supplementation in men with type 2 diabetes, visceral obesity and partial androgen deficiency. Aging Male 2003, 6:1–7.

    PubMed  CAS  Google Scholar 

  36. Wang C, Swerdloff RS, Iranmanesh A, et al.: Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. J Clin Endocrinol Metab 2000, 85:2839–2853.

    Article  PubMed  CAS  Google Scholar 

  37. Shabsigh R, Katz M, Yan G, Makhsida N: Cardiovascular issues in hypogonadism and testosterone therapy. Am J Cardiol 2005, 96:67M-72M. This article reviews the cardiac safety and potential benefits of testosterone replacement therapy in the treatment of hypogonadism.

    Article  PubMed  CAS  Google Scholar 

  38. Nicolosi A, Glasser DB, Moreira ED, Villa M: Prevalence of erectile dysfunction and associated factors among men without concomitant diseases: a population study. Int J Impot Res 2003, 15:253–257.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 671 Hoes Lane, 08854, Piscataway, NJ, USA

    Raymond C. Rosen PhD

Authors
  1. Raymond C. Rosen PhD
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  2. Graham Jackson MD
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  3. John B. Kostis MD
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Correspondence to Raymond C. Rosen PhD.

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Rosen, R.C., Jackson, G. & Kostis, J.B. Erectile dysfunction and cardiac disease: Recommendations of the second princeton conference. Curr Urol Rep 7, 490–496 (2006). https://doi.org/10.1007/s11934-006-0060-7

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  • DOI: https://doi.org/10.1007/s11934-006-0060-7

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