Years ago, Viagra made the unexpected transition from hypertension and angina drug contender to erectile-dysfunction blockbuster, only to journey back as a treatment for PAH. Recent years have seen a flurry of studies suggesting that erectile dysfunction and coronary disease are closer cousins than ever expected.
Results from a new analysis of the ADVANCE trial shows that baseline ED is associated with a 19% higher risk of cardiovascular disease events, a 35% increased risk of coronary heart disease, and a 36% increased risk of cerebrovascular disease.
The greatest risk was for deep vein thrombosis in men with prostate cancer on endocrine therapy, whose risk was more than doubled. Teasing out the risk associated with the disease process, choice of therapy, and other patient factors requires further study.
After adjustment for conventional risk factors, men with ED are at a 40% greater risk of developing cardiovascular disease than men without ED. Still, the addition of ED did not improve the prediction of cardiovascular-disease incidence in men beyond that of conventional risk factors.
In what may be the first clinical trial to test a DES in the pudendal artery, investigators at nine sites are looking at whether pudendal stenting is safe and effective in men who have failed PDE-5 inhibitors.
Two new trials confirm that erectile dysfunction should be treated as a powerful early-warning sign for MI and other serious cardiovascular events in patients with diabetes. And one of the studies finds that statins and PDE-5 inhibitors might reduce such events. (Gazzaruso C et al. Ma RCW et al. J Am Coll Cardiol 2008; 51:2040-2044, 2045-2050.)
Researchers find that sexual dysfunction is common among women with hypertension, with a prevalence roughly twice that of normotensive women. They assert that more information on the recognition and management of sexual dysfunction among women with hypertension should be a research priority. (American Society of Hypertension 21st Annual Scientific Meeting and Exposition.)
Researchers say the results from this small pilot study suggest that improving vascular endothelial dysfunction can help improve erectile problems in men who do not initially respond to treatment. (Herrmann HC et al. J Sex Med 2006; 3:303-308.)
Erectile dysfunction is extremely common and could prove to be one of the strongest risk factors to date identified for coronary heart disease, new studies show. Hence, a careful sexual history may provide important clinical information beyond the detection of ED, the researchers conclude. (Min JK et al. Saigal CS et al. Grover SA et al. Arch Intern Med 2006; 166:201-206, 207-212, 213-219.)
A new, prospective study adds heft to the erectile-dysfunction hypothesis, indicating that men with erectile dysfunction and no cardiovascular disease have a 45% chance of having a cardiovascular event within five years. (Thompson IM et al. JAMA 2005; 294:2996-3002.)
Scientists from Johns Hopkins have shown for the first time that sildenafil appears to have a beta-blocker-like effect on the human heart. This indicates that the drug, and others in the same class, may be potential heart-failure therapies, they say. (Borlaug B et al. Circulation 2005; 112: 2642-49.)
A new study has shown that patients with erectile dysfunction have higher levels of CRP, more frequent coronary artery calcifications, and more impaired endothelial function of the brachial artery than men without this condition, providing further weight to the idea that erectile dysfunction represents an early clinical manifestation of coronary artery disease. (Chiurlia E et al. J Am Coll Cardiol 2005; 46:1503-1506.)