First Pants- then Heart Failure

29. July 2010
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Men suffering from erectile dysfunction have an increased risk of coronary heart diseases. An analysis shows: Patients with erectile dysfunctions frequently develop cardiovascular symptoms within two to three years of appearance of the problem.

The association between erectile dysfunction (ED) and coronary heart diseases (CHD) has been subject of discussions for a while. The recently published meta-analysis made by an international team of researchers underlined this association now with valid data – they clearly verify the alliance between ED and CHD and which explosives for health it holds.
According to the London cardiologist Dr. Graham Jackson, head of the 11 scientists, organically caused erectile dysfunctions and CHD are closely connected: “Both result from the same endothelial pathology causing restraint blood flow rates”. Accordingly the scientists identified the same risk factors for both diseases, among others hypertension, overweight and lipometabolic disorders. “In our study, we wanted to check the hypothesis whether erectile dysfunctions are a predictor for coronary heart diseases and if so how can the affected patients manage the risks”, explains Dr. Jackson.

Harbinger of coronary heart disease

Dr. Jackson’s team found out that erectile dysfunction must clearly be considered as a “decisive predictor” for coronary heart diseases – most of all in young men age 40 to 69. According to the London cardiologist “there is clear evidence in the study data”: In two thirds of the patients, erectile dysfunctions precede the manifestation of a CHD. The majority of the ED patients had early symptoms of CHD like reduced coronary flow rate reserves, vasodilatation and calcification of coronary arteries. In addition the damages at the penis vessels are accompanied by “significant changes of cardiovascular risk parameters like glucose, homocysteine and C-reactive protein”. It also showed that in general ED patients develop a more sever CHD than healthy men and that the severity of ED correlates with the severity of CHD. The interval between the occurrence of erectile dysfunctions and the symptoms of CHD is an average of two to three years. It takes a median of three to five years until the first cardiovascular incident such as myocardial infarction or apoplexy.

“For ED patients age 30 to 39, the CHD risk increases by 14%, for those age 60 and 69 by 21%”, says Jackson.
Particularly impressive are the results of the Massachusetts Male Aging Study (MMAS) which included 1709 men. Those with erectile dysfunctions had an increased general mortality risk of 26 percent. The death rate caused by coronary heart diseases in ED patients was even 43 percent higher. Erectile dysfunction proved to be just as much predictive for cardiovascular mortality in the ONTARGET/TRANSEND-study.

The reasons for endothelial damages showing rather early on a man’s best friend are anatomical. Arteries in the penis are smaller than those in the myocardium. Thus atherosclerotic changes show earlier. According to Dr. Jackson, this is further supported by the fact that men with erectile dysfunctions hardly ever complain about cardiovascular problems. On the other hand, CHD patients report very often about prior problems with their erection.

Enough room for comprehensive action

The results of the meta-analysis enable a number of consequences – especially since the interval between manifestation of erectile dysfunctions and CHD allows an on-time intervention. In these premises, the team around Dr. Jackson urges to medically examine ED patients intensively without exception. All affected persons have to be stratified regarding their cardiovascular risk. Men with an increased CHD risk should receive further examination, for example with electrocardiographs or computer tomography. In addition these risk patients should keep a sexual waiting period until their cardiovascular status has stabilized.

In the opinion of the group of experts, it is also vital to determine the testosterone level: “All ED patients have to be screened regarding their level of bound and free testosterone”. The Testosterone-Deficiency-Syndrome (TDS) is a known reason for erectile dysfunctions and goes along with an increased cardiovascular risk – with growing evidence. “Since TTDS is associated with type-2 diabetes, metabolic syndrome, lipometabolic disorders as well as abnormal coagulation, it definitely has the same relevance as other cardiovascular risk factors”, says Dr. Jackson. In cases of reduced testosterone level, a testosterone replacement therapy is recommended – which also promotes the effects of PDE5 inhibitors.

Essential: Healthy life style and individualized medication

Improvement of the life style plays an important role. According to Dr. Jackson it is very effective “to prevent future cardiovascular events”. Reduced intake of calories and increased physical activities decrease the concentration of inflammatory substances like CRP and others and it improves the ability for erection. “It has its reasons – the incidence of erectile dysfunctions is significantly lower in men with normal weight and an active life style than in less health-conscious men the same age”. Parallel to a change to a healthier life style, cardiovascular risk factors such as hypertension, type-2 diabetes and disorders of the fat metabolism are manageable by suitable medication. And this medication should be adjusted carefully to the individual problems o the patient since “some cardiovascular effective drugs worsen erectile dysfunction”. According to Dr. Jackson, angiotensin-II receptor blockers have proven to be the first choice for ED patients suffering from hypertension. In cases with parallel lipometabolic disorders, statins are recommendable: They correct blood fat levels effectively and improve erectile dysfunction”.

Phosphodiesterase5-inhibitors are first-line-therapy

The first treatment of patients with ED and CHD should be done – in accordance with the clinical evidence – with PDE5-inhibitors: Their effectiveness and safety for improvement of erectile dysfunctions of patients with manifested CHD or cardiovascular risk factors has been proven in numerous randomized clinical studies”, explains the London cardiologist. In addition it has shown that sildenafil and tadalafil are not associated with an increased risk for cardiovascular events. Also with type-2 diabetes patients with erectile dysfunction Dr. Jackson recommends the first-line-therapy with PDE5-inhibitors. Men with moderate to medium cardiac insufficiency or stable CHD should get sildenafil since those PDE5-inhibitors have very little cardiovascular side-effects. ED patients taking different hypertensive medications, tolerate vardenafil and sildenafil well also. Dr. Jackson’s team also recommends vardenafil for those patients suffering from both, high blood pressure and lipometabolic disorders. Tadalafil again is suitable for hypertensive ED patients being treated with thiazides. During a therapy with nitrates, PDE5-inhibitors are counter-indicated since they exponentiate their effect. Here Dr. Jackson recommends treating the patient “with an alternative anti-ischemic medication”. But a therapy interruption of at least one week should be ensured between stopping the nitrates and starting the PDE5-inhibitor.

Where oral medication proves to be ineffective against ED, therapeutic strategies like for example vacuum pumps, intracavernous injection or implantation of the penis prosthesis are indicated.

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