Vascular disease most common cause of male erectile dysfunction

A preeminent cardiologist reports, for the first time in a large prospective study, that certain of his patients with erectile dysfunction (ED) and heart problems can now safely use erection drugs that help up to 80% of men restore function and quality of life.

Dr. Graham Jackson, who established a unique clinic in England dedicated to providing sexual advice to men with cardiac disease and ED, conducted the largest scientific study of its kind, on 425 men with ED and cardiac disease. In the study, appearing in the July issue of The Journal of Sexual Medicine, Dr. Jackson wished to see if stable coronary patients with ED could have their oral nitrates discontinued to allow for safe use of a PDE-5 inhibitor, such as Viagra, Levitra or Cialis.

More than half of the men on oral nitrates who were clinically stable with good ability to exercise had their nitrates discontinued in the presence of continuing beta-blockade or calcium antagonist therapy and close follow-up. Over 90% of the men no longer taking nitrates were treated with a PDE-5 inhibitor which was effective in restoring sexual function in 85%. Importantly, there have been no adverse cardiac events in the group.

"This is a huge, groundbreaking advance in our field that shows how multidisciplinary sexual medicine really is," states Irwin Goldstein MD, Editor-in-Chief of The Journal of Sexual Medicine. "Coordinating care between the sexual medicine physician and the cardiologist has provided new evidence-based, prospective data to support better clinical care for those men with ED and cardiac disease, who historically have been denied such care. We now know that oral nitrates can be discontinued in the presence of continuing beta blockade and/or calcium antagonist therapy in stable coronary disease patients with ED to allow for the safe use of PDE-5 inhibitors."

The Center for Disease Control and Prevention estimates that 1 in 12 (8%) or 22 million adults in the US have heart disease. In the US, the prevalence rate for those who have angina pectoris is 17.5 per 1000 people. Nitrate therapy is an absolute contraindication to the use of PDE-5 inhibitors, however, since oral nitrates confer little benefit when added to optimum doses of betablockers and/or calcium antagonists, it followed that stable patients may be able to have their nitrate therapy discontinued or exchanged for a drug that does not react with a PDE-5 inhibitor, such as a calcium antagonist or beta blocker.

"If you are on nitrates, the best advice is to see your doctor,” says Dr. Goldstein.

http://jsm.issir.org