Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference).
Recent studies have highlighted the relation between erectile dysfunction (ED) and cardiovascular disease. In particular, the role of endothelial dysfunction and nitric oxide in ED and atherosclerotic disease has been elucidated. Given the large number of men receiving medical treatment for ED, concerns regarding the risk for sexual activity triggering acute cardiovascular events and potential risks of adverse or unanticipated drug interactions need to be addressed. A risk stratification algorithm was developed by the First Princeton Consensus Panel to evaluate the degree of cardiovascular risk associated with sexual activity for men with varying degrees of cardiovascular disease. Patients were assigned to 3 categories: low, intermediate (including those requiring further evaluation), and high risk. This consensus study from the Second Princeton Consensus Conference corroborates and clarifies the algorithm and emphasizes the importance of risk factor evaluation and management for all patients with ED. The panel reviewed recent safety and drug interaction data for 3 phosphodiesterase (PDE)-5 inhibitors (sildenafil, tadalafil, vardenafil), with emphasis on the safety of these agents in men with ED and concomitant cardiovascular disease. Increasing evidence supports the role of lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease. Special management recommendations for patients taking PDE-5 inhibitors who present at the emergency department and other emergency medical situations are described. Finally, further research on the role of PDE-5 inhibition in treating patients with other medical or cardiovascular disorders is recommended.
Kostis
John B
JB
University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ, USA. kostis@umdnj.edu
Jackson
Graham
G
Rosen
Raymond
R
Barrett-Connor
Elizabeth
E
Billups
Kevin
K
Burnett
Arthur L
AL
Carson
Culley
C
Cheitlin
Melvin
M
Debusk
Robert
R
Fonseca
Vivian
V
Ganz
Peter
P
Goldstein
Irwin
I
Guay
Andre
A
Hatzichristou
Dimitris
D
Hollander
Judd E
JE
Hutter
Adolph
A
Katz
Stuart
S
Kloner
Robert A
RA
Mittleman
Murray
M
Montorsi
Francesco
F
Montorsi
Piero
P
Nehra
Ajay
A
Sadovsky
Richard
R
Shabsigh
Ridwan
R
D017677:Age Distribution; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology; D004347:Drug Interactions; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D011379:Prognosis; D011687:Purines; D018570:Risk Assessment; D012720:Severity of Illness Index; D000068677:Sildenafil Citrate; D013450:Sulfones; D015996:Survival Rate
D002317:Cardiovascular Agents; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate