Co by měl vědět kardiolog o erektilní dysfunkci?

Cor Vasa 2003, 44(5):263-268

What should the cardiologist know about erectile dysfunction?

Václav Chaloupka: Oddělení funkčního vyšetřování, Fakultní nemocnice Brno-Bohunice, Brno, Česká republika

Erectile dysfunction (ED), defined as an inability to achieve or maintain erection sufficient for a satisfactory sexual intercourse, occurs in more than 30% of men aged 40-70 years. ED is more frequent in patients with coronary heart disease than in the general population. It is estimated that ED afflicts over 150 million men worldwide, with the figure expected to rise to more than 300 million men by the year 2025. The etiology of ED is most often vascular, so its association with coronary heart disease is fairly close. The incidence of both conditions rises with age and both conditions have common risk factors.
In general, the risk of serious cardiovascular events as a result of sexual intercourse is very low in individuals both with and without a history of a coronary event. An international conference, attended by prominent experts, was held in Princeton (1999); the event resulted in guidelines for identifying the risk associated with sexual activity, and for the management of sexual dysfunction in patients with cardiovascular disease.
The era of modern drug therapy began four years ago with the introduction of sildenafil into clinical practice. Sildenafil, a selective PDE5 (phosphodiesterase 5) inhibitor, was originally tested as a drug for patients with angina; it has nitrate-like effects. As a result, its concomitant use with nitrates is contraindicated because of the potential for boosting the vasodilator action, and the risk of hypotension for at least a 24-hour period. In patients with heart disease, i. e., mainly with coronary heart disease, the effect of sildenafil is rather positive or neutral.
Sildenafil and the recently approved centrally-acting apomorphine SL have been joined by tadalafil, presently receiving marketing authorization, while vardenafil, a new PDE5 inhibitor, is to become available on the market soon.
At present, research has also focused on the possibility to use PDE5 inhibition in the management of heart failure, pulmonary hypertension, and endothelial dysfunction.