Erectile dysfunction in patients with coronary artery disease.
Recent studies suggest that erectile dysfunction (ED) may be an early marker of endothelial dysfunction and coronary artery disease (CAD). Conversely, patients with CAD commonly have ED. The phosphodiesterase 5 (PDE5) inhibitors are very effective for the treatment of ED in patients with CAD. Numerous studies show that this class of drugs is in general safe in patients with stable CAD and these agents do not exacerbate ischemia in men with CAD undergoing exercise stress testing. Analysis of placebo-controlled trials did not show an increase in cardiovascular events among men receiving PDE5 inhibitors, and post-marketing surveillance studies with sildenafil did not observe an increase in cardiovascular events compared to expected age-matched rates. Organic nitrates remain a contraindication for PDE5 inhibitors and alpha blockers have precautions/contraindications depending upon specific drugs. The Princeton Consensus Guidelines (soon to be updated) suggest a logical approach to the patient with CAD seeking therapy for sexual dysfunction.
Kloner
R
R
Heart Institute, Good Samaritan Hospital (USC), Los Angeles, CA 90017, USA. rkloner@goodsam.org
Padma-Nathan
H
H
D015106:3',5'-Cyclic-GMP Phosphodiesterases; D002986:Clinical Trials as Topic; D000075202:Contraindications; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5; D004347:Drug Interactions; D004730:Endothelium, Vascular / Q000503:physiopathology; D007172:Erectile Dysfunction / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000453:epidemiology; D009566:Nitrates / Q000009:adverse effects; D010726:Phosphodiesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D010727:Phosphoric Diester Hydrolases; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use; D011687:Purines; D000068677:Sildenafil Citrate; D013450:Sulfones
D009566:Nitrates; D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate; D010727:Phosphoric Diester Hydrolases; D015106:3',5'-Cyclic-GMP Phosphodiesterases; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5; C517381:PDE5A protein, human