Sexual Dysfunction and Cardiovascular Risk – Links and Solutions

Abstract

Erectile dysfunction (ED) is an increasingly common problem, affecting up to 30 million men in the US and 140 million men worldwide. The prevalence and incidence of ED is closely related to an aging population and also to an increase in other associated risk factors (such as type 2 diabetes mellitus (T2DM), hypertension, atherosclerosis, smoking and polypharmacy). Several of these risk factors for ED are also components of the metabolic syndrome. The metabolic syndrome refers to a clustering of established and emerging cardiovascular (CV) risk factors within a single individual. The diagnosis of the metabolic syndrome in an individual increases the risk of subsequent cardiovascular disease (CVD) approximately twofold and T2DM fivefold. Endothelial dysfunction is a major unifying etiology for many of the aspects of the metabolic syndrome, especially T2DM and CVD. It also plays a major role in ED. In fact, the presentation of ED should alert the physician to an underlying CV problem particularly in a patient with T2DM. This should lead to screening for CV risk factors and appropriate risk stratification for asymptomatic men with ED. Men with ED and other CV risk factors should be counseled in lifestyle modification, and treated where indicated with agents aimed at reducing CV risk (i.e., statins, aspirin, antihypertensives, etc). Treatment of ED in general and in men with diabetes has been revolutionized with the introduction of phosphodiesterase type 5 (PDE5) inhibitors. However, men with diabetes tend to respond less well to these agents. This decreased responsiveness may relate to the severity of ED in diabetes. Alternative therapeutic strategies may be needed to overcome this problem. The safety of PDE5 inhibitors in men with ED and concomitant CVD seems to be generally accepted, especially when these agents are used according to the respective prescribing information and as per current guidelines.