Erectile dysfunction in the cardiac patient: how common and should we treat?
OBJECTIVE
Risk factors for erectile dysfunction (ED) (hypertension, diabetes, smoking, lipid abnormality) are also risk factors for coronary artery disease. However, most cardiologists do not routinely ask about ED and patients often are reluctant or embarrassed to discuss it. We determined how common ED was in a group of patients with chronic stable coronary artery disease.


METHODS
We administered the validated Sexual Health Inventory for Men (SHIM) 5-item questionnaire, based on the International Index of Erectile Function questionnaire, to 76 men with chronic stable coronary artery disease during routine outpatient cardiology visits. Most of these men had not previously discussed ED with their cardiologist.


RESULTS
The mean patient age was 64 years (range 40 to 82). The questionnaire took about 5 minutes to complete. Of the patients 47% were on beta blockers, 92% statins, 28% diuretics. SHIM score was 21 or less in 53 men (70%), which is indicative of ED. Of the patients 75% had some difficulty achieving erections (question 2) and 67% had some difficulty maintaining an erection after penetration (question 3). The questionnaire reflected successful sildenafil treatment in 4 patients (SHIM scores 23 to 25). If these 4 men are included as having had ED then 57 of 76 (75%) had ED or recent history of ED.


CONCLUSIONS
ED is extremely common in men with chronic coronary artery disease (affecting approximately 75%) yet most cardiologists do not ask about it. The SHIM is a useful, quick and inexpensive tool for discussion and diagnosis of ED in this population. Although it is well established that cardiovascular risk factors are associated with erectile dysfunction, once it is present there is mixed information on whether treating the risk factors will treat the ED. Problems appear to be that lifestyle modification in midlife may simply be too late to effect a change, and some antihypertensive and lipid lowering drugs may actually exacerbate ED. Oral therapy for ED, namely the PDE5 inhibitors, is effective and safe in most cardiac and hypertensive patients. Organic nitrates such as nitroglycerin remain a contraindication to the concomitant use of these drugs. Guidelines for treatment of ED in the cardiac patient issued by the American College of Cardiology/American Heart Association and Princeton Guidelines may be useful in the approach to the cardiac patient with ED.
Kloner
Robert A
RA
Heart Institute, Good Samaritan Hospital, 1225 Wilshire Blvd., Los Angeles, California 90017, USA. rkloner@goodsam.org
Mullin
Stephanie H
SH
Shook
Thomas
T
Matthews
Ray
R
Mayeda
Guy
G
Burstein
Steve
S
Peled
Harry
H
Pollick
Charles
C
Choudhary
Ranji
R
Rosen
Raymond
R
Padma-Nathan
Harin
H
D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007093:Imidazoles; D008019:Life Style; D008297:Male; D010410:Penile Erection / Q000187:drug effects / Q000502:physiology; D010879:Piperazines / Q000494:pharmacology; D011687:Purines; D012307:Risk Factors; D000068677:Sildenafil Citrate; D012907:Smoking / Q000453:epidemiology; D013450:Sulfones; D014227:Triazines; D000069058:Vardenafil Dihydrochloride
D007093:Imidazoles; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014227:Triazines; D000069058:Vardenafil Dihydrochloride; D000068677:Sildenafil Citrate