title: Diagnosis and treatment of erectile dysfunction for reduction of cardiovascular risk.
abstract: OBJECTIVE
  We established erectile dysfunction as an often neglected but valuable marker of cardiovascular risk, particularly in younger men and men with diabetes. We also reviewed evidence that lifestyle change, combined with informed prescribing of pharmacotherapies used to mitigate cardiovascular risk, can improve overall vascular health and sexual functioning in men with erectile dysfunction.
  
  
  METHODS
  We performed a PubMed® search for articles and guidelines pertinent to relationships between erectile dysfunction and cardiovascular disease, cardiovascular and all cause mortality, and pharmacotherapies for dyslipidemia and hypertension. The clinical guidance presented incorporates the current literature and the expertise of the multispecialty investigator group.
  
  
  RESULTS
  Numerous cardiovascular risk assessment tools exist but risk stratification remains challenging, particularly in patients at low or intermediate short-term risk. Erectile dysfunction has a predictive value for cardiovascular events that is comparable to or better than that of traditional risk factors. Interventional studies support lifestyle changes as a means of improving overall vascular health as well as sexual functioning. Statins, diuretics, β-blockers and renin-angiotensin system modifiers may positively or negatively affect erectile function. Furthermore, the phosphodiesterase type 5 inhibitors used to treat erectile dysfunction may have systemic vascular benefits.
  
  
  CONCLUSIONS
  Erectile dysfunction treatment should be considered secondary to decreasing cardiovascular risk. However, informed prescribing may prevent worsening sexual function in men receiving pharmacotherapy for dyslipidemia and hypertension. As the first point of medical contact for men with erectile dysfunction symptoms, the primary care physician or urologist has a unique opportunity to identify those who require early intervention to prevent cardiovascular disease.
authors: Department of Urology, Rush University Medical Center, Chicago, Illinois 60612, USA. Ajay_Nehra@rush.edu
authors: Ajay
authors: A
authors: Nehra
authors: Graham
authors: G
authors: Jackson
authors: Martin
authors: M
authors: Miner
authors: Kevin L
authors: KL
authors: Billups
authors: Arthur L
authors: AL
authors: Burnett
authors: Jacques
authors: J
authors: Buvat
authors: Culley C
authors: CC
authors: Carson
authors: Glenn R
authors: GR
authors: Cunningham
authors: Irwin
authors: I
authors: Goldstein
authors: Andre T
authors: AT
authors: Guay
authors: Geoff
authors: G
authors: Hackett
authors: Robert A
authors: RA
authors: Kloner
authors: John
authors: J
authors: Kostis
authors: Piero
authors: P
authors: Montorsi
authors: Melinda
authors: M
authors: Ramsey
authors: Raymond C
authors: RC
authors: Rosen
authors: Richard
authors: R
authors: Sadovsky
authors: Allen D
authors: AD
authors: Seftel
authors: Charalambos
authors: C
authors: Vlachopoulos
authors: Frederick C W
authors: FC
authors: Wu
mesh_terms: D017677:Age Distribution; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015897:Comorbidity; D007172:Erectile Dysfunction / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D058986:Phosphodiesterase 5 Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D016896:Treatment Outcome
chemical_list: D058986:Phosphodiesterase 5 Inhibitors