18 research outputs found
The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician.
Erectile dysfunction (ED) and cardiovascular disease (CVD) share risk factors and frequently coexist, with endothelial dysfunction believed to be the pathophysiologic link. ED is common, affecting more than 70% of men with known CVD. In addition, clinical studies have demonstrated that ED in men with no known CVD often precedes a CVD event by 2-5 years. ED severity has been correlated with increasing plaque burden in patients with coronary artery disease. ED is an independent marker of increased CVD risk including all-cause and especially CVD mortality, particularly in men aged 30-60 years. Thus, ED identifies a window of opportunity for CVD risk mitigation. We recommend that a thorough history, physical exam (including visceral adiposity), assessment of ED severity and duration and evaluation including fasting plasma glucose, lipids, resting electrocardiogram, family history, lifestyle factors, serum creatinine (estimated glomerular filtration rate) and albumin:creatinine ratio, and determination of the presence or absence of the metabolic syndrome be performed to characterise cardiovascular risk in all men with ED. Assessment of testosterone levels should also be considered and biomarkers may help to further quantify risk, even though their roles in development of CVD have not been firmly established. Finally, we recommend that a question about ED be included in assessment of CVD risk in all men and be added to CVD risk assessment guidelines
Erectile Dysfunction as an Independent Predictor of Future Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis
Vascular erectile dysfunction (ED) and cardiovascular disease (CVD) share common risk factors including obesity, hypertension, metabolic syndrome, diabetes mellitus, and smoking. ED and CVD also have common underlying pathological mechanisms, including endothelial dysfunction, inflammation, and atherosclerosis.1 Despite these close relationships, the evidence documenting ED as an independent predictor of future CVD events is limited
Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk
Testosterone plays a central role in male development and health. Likewise, androgen deficiency, or hypogonadism, is associated with a variety of symptoms including decreased energy, diminished libido and erectile dysfunction, among others. Male androgen levels steadily decline with age, and, in a subset of symptomatic older men, can result in late-onset hypogonadism (LOH). Over the last decade, increased awareness of hypogonadism among patients and providers has led to a significant rise in the use of testosterone replacement therapy (TRT) for hypogonadism, and especially in LOH. Accompanying the rise in TRT are concerns of potential adverse effects, including cardiovascular risks and the promotion of prostate cancer. The ‘androgen hypothesis’ asserts that prostate cancer development and progression is driven by androgens, and thus TRT has the theoretical potential to drive prostate cancer development and progression. In this review, we examine existing data surrounding testosterone and prostate cancer. There is significant evidence that androgens promote prostate cancer in experimental systems. However, there is no clear evidence that elevations in endogenous testosterone levels promote the development of prostate cancer in humans. As a result of experimental and historical data on the progression of prostate cancer following TRT, there has been widespread belief that TRT will promote disease progression in prostate cancer patients. Despite these fears, there are a growing number of studies demonstrating no increase in prostate cancer incidence among men on TRT. Furthermore, in studies involving a small number of patients, there has been no discernable increase in disease progression in prostate cancer patients on TRT. While data from large, prospective, randomized, controlled trials are absent, TRT in select prostate cancer patients is likely safe. In the end, the use of TRT in prostate cancer patients is still considered experimental and should only be offered after well-informed shared decision making and with close monitoring
Subclinical Vascular Disease and Subsequent Erectile Dysfunction: The Multiethnic Study of Atherosclerosis (MESA).
BackgroundThe association between subclinical cardiovascular disease and subsequent development of erectile dysfunction (ED) remains poorly described.HypothesisAmong multiple subclinical atherosclerosis and vascular dysfunction measurements, coronary artery calcium (CAC) score best predicts ED.MethodsAfter excluding participants taking ED medications at baseline, we studied 1862 men age 45 to 84 years free of known cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA) with comprehensive baseline subclinical vascular disease phenotyping and ED status assessed at MESA visit 5 (9.4 ± 0.5 years after baseline) using a standardized question on ED symptoms. Multivariable logistic regression was used to assess the associations between baseline measures of vascular disease (atherosclerosis domain: CAC, carotid intima-media thickness, carotid plaque, ankle-brachial index; vascular stiffness/function domain: aortic stiffness, carotid stiffness, brachial flow-mediated dilation) and ED symptoms at follow-up.ResultsMean baseline age was 59.5 ± 9 years, and 839 participants (45%) reported ED symptoms at follow-up. Compared with symptom-free individuals, participants with ED had higher baseline prevalence of CAC score >100 (36.4% vs 17.2%), carotid intima-media thickness Z score >75th percentile (35.3% vs 16.6%), carotid plaque score ≥2 (39% vs 21.1%), carotid distensibility <25th percentile (34.6% vs 17.1%), aortic distensibility <25th percentile (34.2% vs 18.7%), and brachial flow-mediated dilation <25th percentile (28.4% vs 21.3%); all P < 0.01. Only CAC >100 (odds ratio: 1.43, 95% confidence interval: 1.09-1.88) and carotid plaque score ≥2 (odds ratio: 1.33, 95% confidence interval: 1.02-1.73) were significantly associated with ED.ConclusionsSubclinical vascular disease is common in men who later self-report ED. Early detection of subclinical atherosclerosis, particularly advanced CAC and carotid plaque, may provide opportunities for predicting the onset of subsequent vascular ED
The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease
The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up. The second objective focused on reevaluation and modification of previous recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD. The Panel's recommendations build on those developed during the first and second Princeton Consensus Conferences, first emphasizing the use of exercise ability and stress testing to ensure that each man's cardiovascular health is consistent with the physical demands of sexual activity before prescribing treatment for ED, and second highlighting the link between ED and CVD, which may be asymptomatic and may benefit from cardiovascular risk reductio
Diagnosis and Treatment of Erectile Dysfunction for Reduction of Cardiovascular Risk
Purpose: We established erectile dysfunction as an often neglected but
valuable marker of cardiovascular risk, particularly in younger men and
men with diabetes. We also reviewed evidence that lifestyle change,
combined with informed prescribing of pharmacotherapies used to mitigate
cardiovascular risk, can improve overall vascular health and sexual
functioning in men with erectile dysfunction.
Materials and Methods: We performed a PubMed (R) search for articles and
guidelines pertinent to relationships between erectile dysfunction and
cardiovascular disease, cardiovascular and all cause mortality, and
pharmacotherapies for dyslipidemia and hypertension. The clinical
guidance presented incorporates the current literature and the expertise
of the multispecialty investigator group.
Results: Numerous cardiovascular risk assessment tools exist but risk
stratification remains challenging, particularly in patients at low or
intermediate short-term risk. Erectile dysfunction has a predictive
value for cardiovascular events that is comparable to or better than
that of traditional risk factors. Interventional studies support
lifestyle changes as a means of improving overall vascular health as
well as sexual functioning. Statins, diuretics, beta-blockers and
renin-angiotensin system modifiers may positively or negatively affect
erectile function. Furthermore, the phosphodiesterase type 5 inhibitors
used to treat erectile dysfunction may have systemic vascular benefits.
Conclusions: Erectile dysfunction treatment should be considered
secondary to decreasing cardiovascular risk. However, informed
prescribing may prevent worsening sexual function in men receiving
pharmacotherapy for dyslipidemia and hypertension. As the first point of
medical contact for men with erectile dysfunction symptoms, the primary
care physician or urologist has a unique opportunity to identify those
who require early intervention to prevent cardiovascular disease
The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease
The Princeton Consensus (Expert Panel) Conference is a multispecialty
collaborative tradition dedicated to optimizing sexual function and
preserving cardiovascular health. The third Princeton Consensus met
November 8 to 10, 2010, and had 2 primary objectives. The first
objective focused on the evaluation and management of cardiovascular
risk in men with erectile dysfunction (ED) and no known cardiovascular
disease (CVD), with particular emphasis on identification of men with ED
who may require additional cardiologic work-up. The second objective
focused on reevaluation and modification of previous recommendations for
evaluation of cardiac risk associated with sexual activity in men with
known CVD. The Panel’s recommendations build on those developed during
the first and second Princeton Consensus Conferences, first emphasizing
the use of exercise ability and stress testing to ensure that each man’s
cardiovascular health is consistent with the physical demands of sexual
activity before prescribing treatment for ED, and second highlighting
the link between ED and CVD, which may be asymptomatic and may benefit
from cardiovascular risk reduction. (C) 2012 Mayo Foundation for Medical
Education and Research Mayo Clin Proc. 2012;87(8):766-77