How is comorbid cardiovascular disease treated in men with erectile dysfunction (ED)?

Updated: Oct 14, 2020
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Many patients with ED also have cardiovascular disease—not surprisingly, given that the two disorders have a common etiology. Treatment of ED in these patients must take cardiovascular risks into account.

Sexual activity, in and of itself, increases the chances of ischemic events and myocardial infarction (MI) because of the exertion and sympathetic activation that may accompany it. The absolute risk of MI during sexual activity and for 2 hours afterward is only 20 chances per million per hour in post-MI patients and is even lower in men without a history of MI. [1]

The Princeton Consensus Panel has produced guidelines for managing ED in patients with cardiovascular disease. [79, 8] The panel advises that a man with ED and no cardiac symptoms should be considered to have cardiac or vascular disease until proven otherwise. ED patients should be assessed and categorized as high-, intermediate-, or low-risk. This stratification can guide management.

Risk-factor modification, including lifestyle interventions (eg, exercise and weight loss) is strongly encouraged for ED patients with cardiovascular disease. A study by Gupta et al supports the view that for men with cardiovascular risk factors, modifications in lifestyle along with pharmacotherapy are helpful in improving sexual function. [80]

Patients who have serious cardiac disease or exertional angina or are taking multiple antihypertensive medications should seek the advice of a cardiologist before beginning therapy with a phosphodiesterase type 5 (PDE5) inhibitor. Nevertheless, several studies examining the cardiac effects of sildenafil and tadalafil have demonstrated that there is no increased risk of cardiovascular events in comparison with placebo. [81, 82] No significant differences in the incidence of MI, myocardial ischemia, or postural hypotension has been reported.

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