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The second Princeton consensus on sexual dysfunction and cardiac risk: new guidelines for sexual medicine
Graham Jackson1, Raymond C Rosen, Robert A Kloner
1Cardiothoracic Center, St Thomas' Hospital, London, UK. gjcardiol@talk21.com
Insights
Erectile dysfunction (ED) is a warning sign for cardiovascular disease. Men with ED should be screened for vascular issues and counseled on lifestyle changes for better heart health.
Area of Science:
- Cardiology
- Urology
- Men's Health
Background:
- Erectile dysfunction (ED) is a common condition, particularly in men over 60.
- ED is strongly linked to cardiovascular disease (CVD) due to shared risk factors and pathophysiology.
- Previous guidelines (Princeton I) established safe management for cardiac patients regarding sexual activity and ED treatment.
Purpose of the Study:
- To update recommendations for managing sexual dysfunction and cardiac risk, incorporating new knowledge and treatments.
- To review and expand upon the Princeton II guidelines.
- To address the safety of phosphodiesterase type 5 (PDE5) inhibitors in men with ED and CVD.
Main Methods:
- A consensus panel of experts reviewed multinational studies on PDE5 inhibitors (sildenafil, tadalafil, vardenafil).
- Emphasis was placed on safety and drug interaction data, particularly for men with ED and cardiovascular disease.
- The review focused on expanding the Princeton II guidelines.
Main Results:
- Erectile dysfunction can be an early indicator of underlying cardiovascular disease.
- Common comorbidities associated with ED include diabetes, hypertension, hyperlipidemia, and heart disease.
- Asymptomatic men with ED should undergo screening for vascular disease, including blood glucose, lipid, and blood pressure measurements.
- Exercise electrocardiograms are recommended for risk stratification in asymptomatic patients at risk for coronary disease.
- Lifestyle interventions like weight loss and increased physical activity are supported by literature for patients with ED and CVD.
Conclusions:
- ED is recognized as a potential warning sign for silent vascular disease.
- Men presenting with ED should be considered at risk for cardiac or vascular issues until proven otherwise.
- Counseling on lifestyle modifications is crucial for men with ED and cardiovascular risk factors such as obesity and sedentary habits.
Introduction:
Erectile dysfunction (ED) is a highly prevalent disorder associated with a significant burden of illness. The prevalence and incidence of ED are strongly age-related, affecting more than half of men >60 years. The first Princeton Consensus Conference (Princeton I) in 1999 developed guidelines for safe management of cardiac patients regarding sexual activity and the treatment of ED.
Aim:
The second conference (Princeton II) was convened to update the recommendations based on the expanding knowledge base and new treatments available. This article reviews and expands on the Princeton II guidelines to address sexual dysfunction and cardiac risk.
Methods:
A consensus panel of experts reviewed recent multinational studies in safety and drug interaction data for three phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil, vardenafil), with emphasis on the safety of these agents in men with ED and concomitant cardiovascular disease.
Results:
Erectile dysfunction is an early symptom or harbinger of cardiovascular disease, due to the common risk factors and pathophysiology mediated through endothelial dysfunction. Major comorbidities include diabetes, hypertension, hyperlipidemia and heart disease. Any asymptomatic man who presents with ED that does not have an obvious cause (e.g., trauma) should be screened for vascular disease and have blood glucose, lipids, and blood pressure measurements. Ideally, all patients at risk but asymptomatic for coronary disease should undergo an elective exercise electrocardiogram to facilitate risk stratification. Lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease, is literature-supported.
Conclusions:
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 (or vascular) patient until proven otherwise. Men with ED and other cardiovascular risk factors (e.g., obesity, sedentary lifestyle) should be counseled in lifestyle modification.
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