[Erectile dysfunction, a new symptom for the cardiologist].

Area of Science:

• Cardiology
• Urology
• Pharmacology

Context:

• Erectile dysfunction (ED) was historically managed by urologists and sexologists with limited treatment options.
• The advent of sildenafil in 1999 revealed the role of endothelial dysfunction and type 5 phosphodiesterase inhibitors (5-PDEI) in treating ED.
• Increased medicalization and media attention have shifted ED management towards cardiology.

Purpose:

• To explore the evolving role of cardiologists in managing erectile dysfunction.
• To address cardiovascular safety concerns associated with 5-PDEI.
• To highlight ED as a potential early marker for cardiovascular disease.

Summary:

• Cardiovascular safety of 5-PDEI has been established in registries, showing good tolerability even in patients with coronary heart disease when nitrates are avoided.
• ED is frequently associated with cardiovascular risk factors, making it a relevant concern for cardiologists.
• Erectile dysfunction is recognized as a potential indicator of silent myocardial ischemia and significant coronary artery disease, prompting further cardiac evaluation.

Impact:

• Cardiologists should consider ED as a "herald of silence" for myocardial ischemia.
• ED necessitates a more proactive approach to evaluating and managing cardiovascular risk factors in patients.
• The Princeton consensus offers guidelines for cardiologists to assess cardiovascular risk in patients presenting with ED.