Microsoft powerpoint - erectile dysfunction and the heart1 - dehaan

• ED is a symptom of many underlying conditions • Endothelial dysfunction seems to be a common final pathway to ED in patients with hyperlipidemia, diabetes mellitus, hypertension, and chronic renal failure • The recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac patient until proven otherwise. • It is estimated that 140 million men worldwide currently experience ED to some degree (Aytac et al, 1999).
• The Massachusetts Male Aging Study (MMAS- 1994), revealed that erectile dysfunction, first emerges as a common problem for men in their early 40s and increases with advancing age (Feldman HA, 1994) • ED was reported in 52% of men aged 40–70 years • The initial event required for penile erection, is primarily a vascular phenomenon, requiring two main processes to occur… 1. Cavernosal artery smooth muscle relaxation – Spinal cord injury– Multiple sclerosis– Dementia – Thyroid d/o– Hypogonadism– Hyperprolactinemia • Chronic Renal Failure• Chronic Liver Failure• Alcoholism• Endocrinologic-thyroid disorders, hypogonadism, • Surgical-radical pelvic surgery (prostatectomy), • Trauma-pelvic fracture, spinal cord injury, etc.
• Cardiovascular Disease • In patients with CVD who also had ED, onset of sexual dysfunction occurred before CVD onset in 93%, with a mean time interval of 24 (12 to 36) months. • The PCPT study established that men with ED were 45% more likely than men without ED to experience a cardiac event after 5 years of follow-up (Thompson et al, 2005).
• In another population-based study of community-dwelling men followed longitudinally, ED was associated with an approximately 80% higher risk of subsequent coronary artery disease at 10 years (Inman et al, 2009). • In a long-term follow-up (15 years) of the Massachusetts Male Aging Study (Feldman et al, 1994), ED was found to be positively associated with subsequent all-cause and cardiovascular disease mortality • The metabolic syndrome (MetS) includes glucose intolerance, insulin resistance, obesity, dyslipidemia, and hypertension.
• Higher prevalence of ED (26.7%) in men with • The prevalence of ED increases as the number of MetS components increases (Esposito et al, 2005). – Medical– Sexual (i.e. IIEF self administered questionnaires)– Psychosocial– Cardiovascular Risk Assessment • Physical Exam (check BP)• Lab Studies – BMP, CBC, HgA1c, Lipid profile, Testosterone, TSH,

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