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The effect of cardiovascular morbidity on clinical response provided by tadalafil in patients with erectile
Ismail Selvi1,2, Numan Baydilli3, Emre Can Akinsal3
1Department of Urology, Karabük University Training and Research Hospital, Karabük, Turkey.
Insights
Erectile dysfunction (ED) is more severe in men with cardiovascular disease. While tadalafil improves erectile function, high-risk patients show less response and higher failure rates, suggesting a need for individualized treatment.
Area of Science:
- Cardiology
- Urology
- Sexual Medicine
Background:
- Cardiovascular morbidity is linked to erectile dysfunction (ED).
- Assessing ED severity and treatment response in cardiovascular risk groups is crucial.
Purpose of the Study:
- To investigate the association between ED severity and cardiovascular morbidity.
- To evaluate tadalafil's clinical response in patients across different cardiovascular risk strata.
Main Methods:
- 258 male patients (45-70 years) with ED were categorized into low, intermediate, and high-risk groups based on Framingham risk score.
- International Index of Erectile Function (IIEF) scores were assessed at baseline and after 12 weeks of tadalafil treatment.
Main Results:
- High-risk patients exhibited worse baseline IIEF scores compared to other groups (p < .001).
- All groups showed improved erectile function, but high-risk patients had lower post-treatment scores (p < .001).
- Complete responsiveness to tadalafil was lowest in the high-risk group (37.7%), with higher failure rates linked to increased Framingham score and baseline ED severity.
Conclusions:
- Severe sexual dysfunction is prevalent in high-risk cardiovascular patients.
- High-risk individuals may experience reduced benefits and higher treatment failure rates with tadalafil.
- Personalized treatment strategies are recommended for high-risk patients with cardiovascular morbidity and ED.
Abstract:
We aimed to investigate the association between erectile dysfunction and severity of cardiovascular morbidity and to assess clinical responses to tadalafil of patients in different cardiovascular risk groups. Between November 2019 and August 2020, a total of 258 male patients aged 45-70 years with ED were included. They were divided into three groups according to the Framingham risk score: low-risk (n: 86, 33.3%), intermediate-risk (n: 103, 39.9%) and high-risk (n: 69, 26.8%). At admission, all domains of the International Index of Erectile Function score were worse in high-risk group compared to other risk groups (p < .001). After a 12-week follow-up, a more significant improvement was observed in all domains of erectile function in all risk groups, but high-risk group had lower sexual scores (p < .001). The lowest rate for complete responsiveness to tadalafil was observed in the high-risk group (37.7%). The rate of failure in complete responsiveness was found to be 4.127 times greater with higher Framingham score and 3.102 times greater with higher erectile dysfunction severity at admission. Our preliminary findings show that more severe sexual disorders are observed in high-risk patients with cardiovascular morbidity. Individualised treatment may be important in high-risk group since they may benefit less from tadalafil, and failure in complete responsiveness can be more common in this group.
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