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ED is common in patients with cardiovascular disease and should be routinely enquired about The cardiac risk of sexual activity in patients with cardiovascular disease is minimal in properly assessed patients The restoration of a sexual relationship is a possibility for the majority of patients with cardiovascular disease and ED using oral PDE5 inhibitors, which have an excellent safety pro le (avoiding nitrate use) ED is a marker for cardiovascular disease as well as its consequence; therefore, its identi cation (in the asymptomatic male) provides the opportunity to address other cardiovascular risk factors and detect silent but signi cant vascular pathology FSD is common and CAD is as common in women as men Women should therefore receive the same cardiovascular risk and therapeutic advice as men Though at present we do not know if FSD is a marker for silent vascular disease, we need to be alert to this possibility
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References
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1 Drory Y Sexual activity and cardiovascular risk Eur Heart J 2002;4(suppl H):H13 18 2 Jackson G, Betteridge J, Dean J, et al A systematic approach to erectile dysfunction in the cardiovascular patient: a consensus statement: update 2002 Int J Clin Pract 2002;56:633 671
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Cardiovascular Issues in Male and Female Sexual Dysfunction
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18 Montorsi P, Montorsi F, Schulman CC Is erectile dysfunction the Tip of the Iceberg of a systemic vascular disorder Eur Urol 2003;44:352 354 19 Kirby M, Jackson G, Simonsen U Endothelial dysfunction links erectile dysfunction to heart disease Int J Clin Pract 2005;59:225 229 20 Montorsi F, Briganti I, Salonia A, et al Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease Eur Urol 2003;44:360 365 21 Billups KL, Bank AJ, Padma-Nathan H, et al Erectile dysfunction is a marker for cardiovascular disease: results of the Minority Health Institute Expert Advisory Panel J Sex Med 2005;2:40 52 22 Solomon H, Man J, Wierzbicki AS, et al Erectile dysfunction: cardiovascular risk and the role of the cardiologist Int J Clin Pract 2003;57:96 99 23 Brock GB, McMahon CG, Chen KK, et al Ef ciency and safety of tadala l for the treatment of erectile dysfunction: results of integrated analysis J Urol 2002;168: 1332 1336 24 Porst H, Rosen R, Padma-Nathan H, et al Ef cacy and tolerability of vardena l, a new selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the rst at home clinical trial Int J Impot Res 2001;13:192 199 25 Gillies HC, Roblin D, Jackson G Coronary and systemic haemodynamic effects of sildena l citrate: from basic science to clinical studies in patients with cardiovascular disease Int J Cardiol 2002;86:131 141 26 Kloner RA, Hutter AM, Emmick JT, et al Time course of the interaction between tadala l and nitrates J Am Coll Cardiol 2004;42:1855 1860 27 Jackson G, Martin E, McGing E, Cooper A Successful withdrawal of oral long-acting nitrates to facilitate phosphodiesterase type 5 inhibitor use in stable coronary disease patients with erectile dysfunction J Sex Med 2005;2:513 516 28 Padma-Nathan H, ed Sildena l citrate (Viagra) and erectile dysfunction: a comprehensive four year update on ef cacy, safety, and management approaches Urology 2002;60(2B):1 90 29 Mittleman MA, MacClure M, Glasser DB Evaluation of acute risk for myocardial infarction in men treated with sildena l citrate Am J Cardiol 2005;96:443 446 30 Jackson G, Gillies H, Osterloh I Past, present and future: a 7-year update of Viagra (sildena l citrate) Int J Clin Pract 2005;59:680 691 31 Fox KM, Thadani U, Ma PTS, et al Sildena l citrate does not reduce exercise tolerance in men with erectile
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dysfunction and chronic stable angina Eur Heart J 2003;24:2206 2212 Herrman HC, Chang G, Klugherz BD, et al Haemodynamic effects of sildena l in men with severe coronary artery disease N Engl J Med 2000;342:1662 1666 Halcox JPJ, Nour KRA, Zalos G, et al The effect of sildena l on human vascular function, platelet activation and myocardial ischaemia J Am Coll Cardiol 2002;40: 1232 1240 Katz SD Potential role of type 5 phosphodiesterase inhibition in the treatment of congestive heart failure Congest Heart Fail 2003;9:9 15 Jackson G, Kloner RA, Costigan TM, et al Update on clinical trials of tadala l demonstrates no increased risk of cardiovascular adverse events J Sex Med 2004;1: 161 167 Kloner RA, Jackson G, Emmick JT, et al Interaction between phosphodiesterase 5 inhibitor, tadala l, and two alpha blockers, doxazosin and tamsulosin, in healthy normotensive men J Urol 2004;172:1935 1940 Thadani U, Smith W, Nash S, et al The effect of vardena l, a potent and highly selective phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction, on the cardiovascular response to exercise in patients with coronary artery disease J Am Coll Cardiol 2002;40: 2006 2012 Wagner G, Montorsi F, Auerbach S, Collins M Sildena l citrate (Viagra) improves erectile function in elderly patients with erectile dysfunction: a subgroup analysis J Geront 2001;50A:M113 119 Shabsigh R, Kaufman JM, Steidle C, Padma-Nathan H Randomised study of testosterone gel as adjunctive therapy to sildena l in hypogonadal men with erectile dysfunction who do not respond to sildena l alone J Urol 2004;172:658 663 Muller M, Van Der Schouw YT, Thijssen JHH, Grobbee DE Endogenous sex hormones and cardiovascular disease in men J Clin Endocrinol Metab 2003;88:5076 5086 Bruckert E, Giral P, Heshmati HM, Turpin G Men treated with hypolipidaemic drugs complain more frequently of erectile dysfunction J Clin Pharm Ther 1996;21:89 94 Jackson G Simvastatin and impotence Brit Med J 1997;351:31 Wenger NK, Collins P, eds Women and Heart Disease London: Taylor & Francis, 2005 Riley AJ, Steiner JA, Cooper R, McPherson CK The prevalence of sexual dysfunction in male and female
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