All Men with Vasculogenic Erectile Dysfunction Require a Cardiovascular Workup - 20/02/14
Doi : 10.1016/j.amjmed.2013.10.013
Martin Miner, MD a, ⁎ 
, Ajay Nehra, MD b, Graham Jackson, MD c, Shalender Bhasin, MD d, Kevin Billups, MD e, f, Arthur L. Burnett, MD f, Jacques Buvat, MD g, Culley Carson, MD h, Glenn Cunningham, MD i, Peter Ganz, MD j, Irwin Goldstein, MD k, Andre Guay, MD l, Geoff Hackett, MD m, Robert A. Kloner, MD, PhD n, John B. Kostis, MD o, K. Elizabeth LaFlamme, PhD p, Piero Montorsi, MD q, Melinda Ramsey, PhD p, Raymond Rosen, PhD r, Richard Sadovsky, MD s, Allen Seftel, MD t, Ridwan Shabsigh, MD u, Charalambos Vlachopoulos, MD v, Frederick Wu, MD w
, Ajay Nehra, MD b, Graham Jackson, MD c, Shalender Bhasin, MD d, Kevin Billups, MD e, f, Arthur L. Burnett, MD f, Jacques Buvat, MD g, Culley Carson, MD h, Glenn Cunningham, MD i, Peter Ganz, MD j, Irwin Goldstein, MD k, Andre Guay, MD l, Geoff Hackett, MD m, Robert A. Kloner, MD, PhD n, John B. Kostis, MD o, K. Elizabeth LaFlamme, PhD p, Piero Montorsi, MD q, Melinda Ramsey, PhD p, Raymond Rosen, PhD r, Richard Sadovsky, MD s, Allen Seftel, MD t, Ridwan Shabsigh, MD u, Charalambos Vlachopoulos, MD v, Frederick Wu, MD w a Departments of Family Medicine and Urology, Miriam Hospital and Brown University, Providence, RI
b Department of Urology, Rush University, Chicago, Ill
c Guy's & St. Thomas Hospital, London, UK
d Department of Medicine, Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Mass
e Department of Urologic Surgery, University of Minnesota, Minneapolis
f The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Md
g Centre d'Etude et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique, Lille, France
h Department of Surgery, Division of Urologic Surgery, University of North Carolina, Chapel Hill
i Departments of Medicine, and Molecular & Cellular Biology, Baylor College of Medicine and St. Luke's Episcopal Hospital, Houston, Tex
j Division of Cardiology, San Francisco General Hospital and University of California, San Francisco, Calif
k San Diego Sexual Medicine, Calif
l Center For Sexual Function/Endocrinology, Lahey Clinic Medical Center, Peabody, Mass, Tufts University School of Medicine, Boston, Mass
m Good Hope Hospital, Birmingham, UK
n Heart Institute, Good Samaritan Hospital and Keck School of Medicine at University of Southern California, Los Angeles
o Cardiovascular Institute, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
p Complete Healthcare Communications, Inc., Chadds Ford, Pa
q Centro Cardiologico Monzino, IRCCS, Institute of Cardiology University of Milan, Italy
r New England Research Institutes, Inc., Watertown, Mass
s Department of Family Medicine, SUNY-Downstate Medical Center, Brooklyn, NY
t Department of Urology, Cooper University Hospital, Camden, NJ
u Division of Urology, Maimonides Medical Center, Brooklyn, NY, and College of Physicians and Surgeons of Columbia University, New York, NY
v 1st Department of Cardiology, Athens Medical School, Athens, Greece
w Andrology Research Unit, Developmental & Regenerative Biomedicine Research Group, University of Manchester, Manchester Academic Health Science Centre, Manchester Royal Infirmary, UK
∗Requests for reprints should be addressed to Martin Miner, MD, Men's Health Center, Department of Family and Community Medicine, Miriam Hospital, 164 Summit Ave., Providence, RI 02906.
Abstract |
An association between erectile dysfunction and cardiovascular disease has long been recognized, and studies suggest that erectile dysfunction is an independent marker of cardiovascular disease risk. Therefore, assessment and management of erectile dysfunction may help identify and reduce the risk of future cardiovascular events, particularly in younger men. The initial erectile dysfunction evaluation should distinguish between predominantly vasculogenic erectile dysfunction and erectile dysfunction of other etiologies. For men believed to have predominantly vasculogenic erectile dysfunction, we recommend that initial cardiovascular risk stratification be based on the Framingham Risk Score. Management of men with erectile dysfunction who are at low risk for cardiovascular disease should focus on risk-factor control; men at high risk, including those with cardiovascular symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo noninvasive evaluation for subclinical atherosclerosis. A growing body of evidence supports the use of emerging prognostic markers to further understand cardiovascular risk in men with erectile dysfunction, but few markers have been prospectively evaluated in this population. In conclusion, we support cardiovascular risk stratification and risk-factor management in all men with vasculogenic erectile dysfunction.
El texto completo de este artículo está disponible en PDF.Keywords : Cardiovascular disease, Erectile dysfunction, Evaluation
Esquema
| Funding: Editorial/medical writing support was provided by Melinda Ramsey and K. Elizabeth LaFlamme at Complete Healthcare Communications, Inc. and was funded by Pfizer. |
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| Conflict of Interest: MM is a consultant to Abbott Laboratories, Chicago, IL, and conducts personal research for Forest Laboratories Inc, New York, NY, and Auxilium Pharmaceuticals Inc, Chesterbrook, PA. GJ is a speaker for Pfizer, New York, NY, Eli Lilly & Co, Indianapolis, IN, and Bayer, Leverkusen, Germany. KB is a consultant to Endo Pharmaceuticals, Chadds Ford, PA, and Abbott Laboratories. ALB is a consultant to Endo Pharmaceuticals, Abbott Laboratories, Timm Medical Technologies, Eden Prairie, MN, VIVUS Inc, Mountain View, CA, Auxilium Pharmaceuticals Inc., and Shionogi Inc., Florham Park, NJ; has received grant support from Pfizer; and has participated in clinical trials for VIVUS Inc and Auxilium Pharmaceuticals Inc. JB is a consultant to Eli Lilly & Co and Nextmed, Tucson, AZ. CC is a consultant to and a speaker for GlaxoSmith-Kline, Eli Lilly & Co, Pfizer, and Auxilium Pharmaceuticals Inc. GC is a consultant to Abbott Laboratories, Endo Pharmaceuticals, GlaxoSmithKline, and Repros Therapeutics, The Woodlands, TX and is a speaker for Abbott Laboratories, Endo Pharmaceuticals, and Merck, Whitehouse Station, NJ. PG is a consultant to Pfizer, Gilead, Forest City, CA, and Roche, Basel, Switzerland. IG is a consultant to Coloplast, Humlebæk, Denmark, Medtronic Vascular, Fridley, MN, Slate Pharmaceuticals, Lake Forest, IL, and VIVUS Inc; a speaker for Abbott Laboratories, Auxilium Pharmaceuticals Inc, Coloplast, Eli Lilly & Co, Endo Pharmaceuticals, Medtronic Vascular, and Slate Pharmaceuticals; performs personal research for Auxilium Pharmaceuticals Inc., BioSante Pharmaceuticals, Lincolnshire, IL, Medtronic Vascular, Slate Pharmaceuticals, and Target Health, New York, NY; and is an expert witness for Pfizer and Bayer. AG is a consultant to Auxilium Pharmaceuticals Inc, Abbott Laboratories, Endo Pharmaceuticals, and Repros Therapeutics. GH is a speaker and conducts personal research for Bayer and Eli Lilly & Co. RAK is a speaker for Pfizer. JBK is a consultant to Merck and Palatin Technologies Inc, Cranbury, NJ; a speaker for Forest Laboratories, Merck, and Sanofi, Bridgewater, NJ; and has received research support from Medtronic and Novartis, Basel, Switzerland. RR is a consultant to Eli Lilly & Co., Boehringer Ingelheim, Palatin Technologies Inc, and Auxilium Pharmaceuticals Inc. RSa is a consultant to Pfizer, Boehringer Ingelheim, and Eli Lilly & Co. AS is a consultant to Auxilium Pharmaceuticals Inc, Endo Pharmaceuticals, Actient RSh is a consultant to Auxilium Pharmaceuticals Inc, Endo Pharmaceuticals, Bayer, and Mezzion Pharma Co., Ltd, Seoul, Korea. CV is a consultant to Eli Lilly & Co. and has received research support from Pfizer. FW is a consultant to Eli Lilly & Co, is a speaker for Galapagos NV, Mechelen, Belgium, and conducts personal research for Bayer. AN, SB, and PM have no conflicts of interest. KEL and MR are employees of Complete Healthcare Communications, Inc. who were paid consultants to Pfizer in connection with the development of this manuscript. |
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| Authorship: All authors contributed to the drafting and critical revision of the article, and all approved the submitted version. |
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