Erectile dysfunction and coronary artery disease prediction: Evidence-based guidance and consensus

G. Jackson, N. Boon, I. Eardley, M. Kirby, J. Dean, G. Hackett, P. Montorsi, F. Montorsi, C. Vlachopoulos, R. Kloner, I. Sharlip, M. Miner

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

A significant proportion of men with erectile dysfunction (ED) exhibit early signs of coronary artery disease (CAD), and this group may develop more severe CAD than men without ED (Level 1, Grade A). The time interval among the onset of ED symptoms and the occurrence of CAD symptoms and cardiovascular events is estimated at 2-3 years and 3-5 years respectively; this interval allows for risk factor reduction (Level 2, Grade B). ED is associated with increased all-cause mortality primarily due to increased cardiovascular mortality (Level 1, Grade A). All men with ED should undergo a thorough medical assessment, including testosterone, fasting lipids, fasting glucose and blood pressure measurement. Following assessment, patients should be stratified according to the risk of future cardiovascular events. Those at high risk of cardiovascular disease should be evaluated by stress testing with selective use of computed tomography (CT) or coronary angiography (Level 1, Grade A). Improvement in cardiovascular risk factors such as weight loss and increased physical activity has been reported to improve erectile function (Level 1, Grade A). In men with ED, hypertension, diabetes and hyperlipidaemia should be treated aggressively, bearing in mind the potential side effects (Level 1, Grade A). Management of ED is secondary to stabilising cardiovascular function, and controlling cardiovascular symptoms and exercise tolerance should be established prior to initiation of ED therapy (Level 1, Grade A). Clinical evidence supports the use of phosphodiesterase 5 (PDE5) inhibitors as first-line therapy in men with CAD and comorbid ED and those with diabetes and ED (Level 1, Grade A). Total testosterone and selectively free testosterone levels should be measured in all men with ED in accordance with contemporary guidelines and particularly in those who fail to respond to PDE5 inhibitors or have a chronic illness associated with low testosterone (Level 1, Grade A). Testosterone replacement therapy may lead to symptomatic improvement (improved wellbeing) and enhance the effectiveness of PDE5 inhibitors (Level 1, Grade A). Review of cardiovascular status and response to ED therapy should be performed at regular intervals (Level 1, Grade A).

Original languageEnglish
Pages (from-to)848-857
Number of pages10
JournalInternational Journal of Clinical Practice
Volume64
Issue number7
DOIs
Publication statusPublished - Jun 2010

Fingerprint

Erectile Dysfunction
Coronary Artery Disease
Consensus
Phosphodiesterase 5 Inhibitors
Testosterone
Fasting
Exercise Tolerance
Mortality
Risk Reduction Behavior
Therapeutics
Hyperlipidemias
Coronary Angiography
Weight Loss
Chronic Disease
Cardiovascular Diseases
Guidelines
Exercise
Blood Pressure
Hypertension
Lipids

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Erectile dysfunction and coronary artery disease prediction : Evidence-based guidance and consensus. / Jackson, G.; Boon, N.; Eardley, I.; Kirby, M.; Dean, J.; Hackett, G.; Montorsi, P.; Montorsi, F.; Vlachopoulos, C.; Kloner, R.; Sharlip, I.; Miner, M.

In: International Journal of Clinical Practice, Vol. 64, No. 7, 06.2010, p. 848-857.

Research output: Contribution to journalArticle

Jackson, G, Boon, N, Eardley, I, Kirby, M, Dean, J, Hackett, G, Montorsi, P, Montorsi, F, Vlachopoulos, C, Kloner, R, Sharlip, I & Miner, M 2010, 'Erectile dysfunction and coronary artery disease prediction: Evidence-based guidance and consensus', International Journal of Clinical Practice, vol. 64, no. 7, pp. 848-857. https://doi.org/10.1111/j.1742-1241.2010.02410.x
Jackson, G. ; Boon, N. ; Eardley, I. ; Kirby, M. ; Dean, J. ; Hackett, G. ; Montorsi, P. ; Montorsi, F. ; Vlachopoulos, C. ; Kloner, R. ; Sharlip, I. ; Miner, M. / Erectile dysfunction and coronary artery disease prediction : Evidence-based guidance and consensus. In: International Journal of Clinical Practice. 2010 ; Vol. 64, No. 7. pp. 848-857.
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