Cardiac Issues Related to Erectile Dysfunction

Abstract

Therapy for erectile dysfunction (ED) has been revolutionized in recent years, since inhibitors of phosphodiesterase-5, such as sildenafil, tadalafil, or vardenafil, were shown to be highly effective in the treatment of ED. Despite theoretical concerns of a reduced tolerance of the myocardium toward ischemia, clinical studies and retrospective analyses did not support an increased cardiac risk with oral treatment of ED. Most importantly, the combination of phosphodiesterase-5 inhibitors with any nitric oxide donor is absolutely contraindicated because of potentially life-threatening hypotension. Before prescribing medication for ED, any patient with cardiovascular disease should be evaluated for a potential risk of a cardiovascular event during sexual activity according to the Princeton Consensus Panel. When a stable cardiac condition can be achieved (low-risk group), oral treatment for ED may be appropriate. On the other hand, a patient presenting with ED should be carefully evaluated regarding cardiovascular risk factors, cardiovascular disease, or other causes of ED, because ED may be a first manifestation of cardiovascular disease. Cardiovascular risk factors should be vigorously treated in these patients.