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News - July 2013
Erectile dysfunction and the heart
You might be surprised to see a news article on erectile dysfunction on my website but it is here for
a very good reason. Not only is it a common problem but it is strongly associated with heart and
circulation problems, such as furred up arteries (atherosclerosis) and high blood pressure.
Erectile dysfunction (ED), a term used to describe difficulty in achieving or maintaining an erection, is
common, particularly in men aged 40 years and older. It occurs in 2 - 9% of men aged 40 - 49 years,
increasing to 50 - 100% in men aged 70 years or more. Although it has been documented for more
than 5000 years, it took until 1998 for the first effective drug treatment, Viagra®, to be introduced.
Viagra® is a selective phosphodiesterase type 5 (PDE5-I) inhibitor which acts by opening up blood
ED is now recognised as a strong predictor of cardiovascular, and in particular heart, disease, such as
angina, heart attack and sudden death. That is perhaps not surprising because ED is associated with
many conditions which predispose to heart problems, such as diabetes mellitus, high blood
pressure, high cholesterol, obesity, smoking, alcohol misuse and lack of exercise. Diseases of the
nervous system, such as multiple sclerosis, stroke and dementia, psychological problems, hormone
imbalance and general illness also contribute. Many drugs have also been linked with ED, including,
somewhat perversely, medicines used to treat heart conditions.
The onset of ED may precede the occurrence of a heart attack or other heart condition by 2 - 3 years, which has led to stricter measures to assess the cardiac status of patients presenting with ED. ED patients who are perceived to have a moderate or high risk of cardiovascular disease should be offered dedicated tests to detect underlying heart problems before treatment of ED is considered. There are a number of different treatment strategies for ED, one of the most common being with PDE5-Is such as Viagra®. However, they cannot be given to patients who are taking nitrates for a heart condition, whether in the form of tablets, e.g. isosorbide mononitrate and dinitrate or in the form of a spray, such as GTN (glyceryl trinitrate), since they will potentiate the blood pressure lowering effect of these agents. Similarly, they can potentiate nicorandil, which contains a nitrate moeity. They should also be used with caution in patients with severe heart conditions or poorly controlled blood pressure and in patients taking alpha blockers for blood pressure control. Vardenafil, another PDE5-I, should be avoided in patients taking some cardiac drugs used to control abnormal heart rhythms, such as quinidine, procainamide, sotalol and amiodarone, and in patients with an ECG abnormality described as a long QT interval.
Dr. Diana Holdright Ltd t/a Dr. Diana R. Holdright
Registered in England: Company Number 8089590, Registered Address: 94 West Parade, Lincoln LN1 1JZ
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