title: Diagnostic and Therapeutic Implications of Erectile Dysfunction in Patients with Cardiovascular Disease.
abstract: Erectile dysfunction (ED) and cardiovascular disease (CVD) share many common pathophysiologic pathways and might be regarded as two different clinical manifestations of the same systemic disease. Consequently, ED and CVD are pathologic conditions that often coexist in the same patient. The urologist plays an important role in the management of ED in patients with a history of cardiovascular events. Therapeutic measures aimed at improving sexual function in CVD patients should be considered only after careful evaluation of the underlying cardiologic condition and assessment of ability to exercise. Sexual activity and treatment of ED might trigger cardiac events in selected patients with preexisting CVD; therefore, proerectile therapies should be administered only to low-risk patients for whom subsequent risk of cardiac events would not be increased. Conversely, men at high risk of CVD should receive cardiologic reassessment and stabilization before attempting sexual activity and receiving ED treatment. Risk reduction and lifestyle changes, administration of phosphodiesterase type 5 inhibitors, and testosterone replacement therapy, as indicated, might provide benefits not only in terms of improving sexual function but also for reducing the risk of future cardiac events.
  
  
  
  Erectile dysfunction (ED) and cardiovascular disease (CVD) share many pathophysiologic mechanisms and often coexist in the same patient. We evaluated the role of the urologist in the management of ED in patients with preexisting CVD and the impact of measures aimed at improving sexual function on the subsequent risk of cardiac events.
authors.affiliation: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Montorsi
authors.affiliation: Olv Vattikuti Robotic Surgery Institute, Melle, Belgium.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mottrie
authors.affiliation: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: montorsi.francesco@hsr.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
mesh_terms: D000728:Androgens / Q000008:administration & dosage / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D007172:Erectile Dysfunction / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D020379:Risk Adjustment; D040242:Risk Reduction Behavior; D012725:Sexual Behavior / Q000502:physiology; D013739:Testosterone / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000728:Androgens; D058986:Phosphodiesterase 5 Inhibitors; D013739:Testosterone
keywords: Cardiovascular events; Cardiovascular mortality; Coronary artery disease; Erectile dysfunction; Phosphodiesterase type 5 inhibitors