Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus
Disclosures G. Jackson has conducted lectures for Lilly and Pfizer during the previous 12 months. N. Boon has no conflict of interests. I. Eardley has acted as a speaker and consultant to Pfizer, Bayer-Schering, Lilly, Boerhinger-Ingelheim. M. Kirby has received funding from the pharmaceutical industry for research, conference fees, travel, lecturing and advice. J. Dean has received payment for consultancy or services as a clinical trial investigator from the following companies in the past 2 years: Bayer-Schering Pharma, Boehringer-Ingelheim, Boots, Johnson & Johnson, Lilly, Pfizer, Plethora and Pro-Strakan. G. Hackett has no conflict of interests. P. Montorsi has no conflict of interests. F. Montorsi has been an investigator and speaker for Bayer-Schering, Lilly and Pfizer and also a Consultant to Bayer-Schering. C. Vlachopoulos has no conflict of interests. R. Kloner has been a speaker and consultant to Lilly and Pfizer. I. Sharlip is an advisory board member and speakers board member for Pfizer, Lilly, Plethora Solutions and Johnson & Johnson. He is a Consultant to Shionogi Pharma. M. Miner is a Consultant to Auxilium and Boehringer-Ingelheim and provides research support to GSK.
Dr Graham Jackson, London Bridge Hospital, 27 Tooley Street, London SE1 2PR,UK
Tel.: 0207 407 5887
Fax: 0207 357 7408
- • 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).