title: Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference).
abstract: 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.
authors.affiliation: University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. kostis@umdnj.edu
authors.forename: John B
authors.initials: JB
authors.lastname: Kostis
authors.forename: Graham
authors.initials: G
authors.lastname: Jackson
authors.forename: Raymond
authors.initials: R
authors.lastname: Rosen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: Kevin
authors.initials: K
authors.lastname: Billups
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
authors.forename: Culley
authors.initials: C
authors.lastname: Carson
authors.forename: Melvin
authors.initials: M
authors.lastname: Cheitlin
authors.forename: Robert
authors.initials: R
authors.lastname: Debusk
authors.forename: Vivian
authors.initials: V
authors.lastname: Fonseca
authors.forename: Peter
authors.initials: P
authors.lastname: Ganz
authors.forename: Irwin
authors.initials: I
authors.lastname: Goldstein
authors.forename: Andre
authors.initials: A
authors.lastname: Guay
authors.forename: Dimitris
authors.initials: D
authors.lastname: Hatzichristou
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.forename: Adolph
authors.initials: A
authors.lastname: Hutter
authors.forename: Stuart
authors.initials: S
authors.lastname: Katz
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kloner
authors.forename: Murray
authors.initials: M
authors.lastname: Mittleman
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Piero
authors.initials: P
authors.lastname: Montorsi
authors.forename: Ajay
authors.initials: A
authors.lastname: Nehra
authors.forename: Richard
authors.initials: R
authors.lastname: Sadovsky
authors.forename: Ridwan
authors.initials: R
authors.lastname: Shabsigh
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D004636:Emergency Service, Hospital; D007172:Erectile Dysfunction / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D011322:Primary Prevention; D012307:Risk Factors; D040242:Risk Reduction Behavior