Archive for May, 2014

Posted on 26 May 2014

Treating ED in Patients with CVD


Recognizing the need for advice on management of ED, two consensus panels (UK and the USA) have produced similar guidelines dividing cardiovascular risk into three practical categories with management recommendations.

The Princeton consensus guidelines have recently been updated. It is recommended that all men with ED should undergo a full medical assessment. Baseline physical activity needs to be established and cardiovascular risk graded low, intermediate, or high. Most patients with low or intermediate cardiac risk can have their ED managed in the out-patient or primary care setting.

There is no evidence that treating ED in patients with cardiovascular disease increases cardiac risk; however, this is with the proviso that the patient is properly assessed and the couple or individual (self-stimulation may be the only form of sexual activity) are appropriately counseled. Oral drug therapy is the most widely used because of its acceptability and effectiveness, but all therapies have a place in management. The philosophy is to always be positive during what, for many men and their partners, is an uncertain time.

Lifestyle Factors

Lifestyle factors have been associated with ED in both cross-sectional and longitudinal studies.

In particular, obesity and sedentary lifestyle are clear cut risk factors for ED, both in men with comorbid illnesses such as hypertension and diabetes, and especially in men without overt CVD. Other lifestyle factors such as smoking and alcohol consumption have been implicated in some, but not all, studies to date.

Intervening on cardiovascular lifestyle factors may have broader benefits beyond restoration of erectile function. This important concept needs careful consideration, as recent studies have implicated the roles of the metabolic syndrome, obesity, insulin resistance, and lack of exercise as independent risk factors for both ED and CVD.

The role of obesity in ED Viagra professional Australia has been confirmed in large scale, cross-sectional, and longitudinal studies. In a study in The Netherlands, 1,700 Dutch men between the ages of 50–75 were evaluated for the presence of ED and other health conditions. Body mass index (BMI) was found to be a significant predictor of ED, both as a single factor and in combination with other risk factors (e.g. lower urinary tract symptoms (LUTS), hypertension, and diabetes).

Lack of physical activity is another lifestyle factor strongly linked to the occurrence of ED in aging men. In the Health Professionals Follow-Up Study, ED was associated with both increased BMI and decreased level of physical activity. Participants were categorized according to their level of exercise or physical activity. Higher levels of sedentary behavior (less physical activity) were found to be a strong independent predictor of ED in this study. Frequent vigorous exercise was associated with an approximate 30% reduction in the risk for ED. Click here to order cheap viagra Australia

The effects of weight loss and exercise were examined further in a randomized intervention trial of lifestyle modification in men with obesity-related ED. This study compared 2 years of exercise and weight loss with an educational control in 110 obese men (mean BMI = 36.4 kg/m2) with moderate to severe ED. Approximately, one third of men in the intervention group achieved normal levels of erectile function following treatment, compared with <5% of men in the control group. Changes in weight loss and exercise were shown to affect endothelial function as measured by forearm rachial Doppler assessment, and were highly correlated with improvements in erection. Taken together, these studies strongly support the role of adverse lifestyle factors in the development and intenance of ED. Obesity and lack of exercise, in particular, have been strongly implicated in a number of cross-sectional and longitudinal studies. At least one long-term prospective study has shown that lifestyle intervention can effectively restore erectile function in a substantial number of men with obesity-related ED, at least among those without significant medical comorbidities. For clinicians, the implications are clear that men with ED and other cardiovascular risk factors (e.g. obesity, sedentary lifestyle) should be counseled on lifestyle modification.