title: [Investigation of diabetic men with erectile dysfunction to determine coronary flow reserve (CFR) and cardiac risk under medication with sildenafil (Viagra)].
abstract: OBJECTIVE
  Since Sildenafil (Viagra) has become available, there have been reports of death and cardiac risks associated with its use. As large doses of Sildenafil medication is often prescribed particularly in diabetic patients with erectile dysfunction (ED), our study was designed to evaluate the coronary flow reserve (CFR) and possible resulting cardiac risk specifically in diabetic men.
  
  
  METHODS
  Because these men often suffer from clinically significant ischaemic heart problems without their knowledge and without symptoms, all of our patients were examined by treadmill ECG and CFR.
  
  
  RESULTS
  In 44 men (35 - 74 years) with type I and II diabetes also suffering from ED objectified by FCDS measurement of the penile vessels, a surprisingly high rate of objective cardiac problems were found, which were then verified by coronary angiography. These patients are at risk for ischaemic problems during Sildenafil-assisted intercourse and were excluded from further study. Interestingly, only 3 of theses 11 men would have been detected by conventional examinations. Patients free of coronary stenosis who received 50 mg Sildenafil (20 patients) showed no cardiac problems during treadmill exercise and CFR measurement.
  
  
  CONCLUSIONS
  Coronary flow reserve in diabetic men lies at the lower end of the normal range, but is not further decreased by Sildenafil. However, diabetics with ED frequently showed coronary artery stenosis that was not clinically symptomatic. Furthermore, conventional cardiological examinations often fail to detect these patients, although they are at ischaemic risk during medically assisted intercourse. Furthermore, although 5 of 20 men who received Sildenafil had an increase in penile blood flow without sexual stimulation, only 7 of 20 were responders to Sildenafil after take home medication. Thus, Sildenafil medication is not a suitable test medication for organic erectile dysfunction.
authors.affiliation: Fachbereiche Urologie, Kardiologie und Diabetologie, Stiftung Deutsche Klinik für Diagnostik GmbH, Wiesbaden. Merkle.uro@dkd.wiesbaden.de
authors.forename: W
authors.initials: W
authors.lastname: Merkle
authors.forename: U
authors.initials: U
authors.lastname: Dietz
authors.forename: C
authors.initials: C
authors.lastname: Jaursch-Hancke
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D000075202:Contraindications; D003326:Coronary Circulation / Q000187:drug effects*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004305:Dose-Response Relationship, Drug; D018618:Echocardiography, Doppler, Color; D005080:Exercise Test; D006801:Humans; D018783:Impotence, Vasculogenic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D010413:Penis / Q000098:blood supply; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects*; D011687:Purines; D012039:Regional Blood Flow / Q000187:drug effects; D018570:Risk Assessment; D000068677:Sildenafil Citrate; D013450:Sulfones; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate