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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Akademisk avhandling Akademisk avhandling som för avläggande av ekonomie doktorsexamen vid Internationella som för avläggande av ekonomie doktorsexamen vid Internationella Handelshögskolan i Jönköping kommer att försvaras i sal B1014, Handelshögskolan i Jönköping kommer att försvaras i sal B1014, Internationella Handelshögskolan i Jönköping, fredagen den 7 mars 2008 kl.