Chapter 15c Erectile Dysfunction
Erectile dysfunction (ED) is common, affecting up to two-thirds of men with known coronary artery disease (CAD) and endothelial dysfunction is now considered the common denominator, explaining the link between ED and CAD in men over 40 years of age with organic ED. Due to the smaller size of the penile arteries (1–2mm), the same degree of endothelial dysfunction may present with ED ahead of CAD (vessel size 3–4mm). It is now established that ED may be a marker of and potentially an independent risk factor for silent CAD with a time window of 2–5 years from the onset of ED to the coronary event. This provides an opportunity for reducing cardiovascular risk in men with ED and no cardiac symptoms, with ED being considered a cardiac or vascular disease equivalent unless and until proved otherwise. ED may present before chronic coronary disease as well as acute coronary syndromes. Exercise testing will not identify subclinical lipid-rich plaque of <50% stenosis which is vulnerable to rupture but recent studies using 64-channel multi-detector computer tomography (MDCT) have identified plaque disease in the presence of normal maximal treadmill exercise electrocardiograms (ECGs) in men with ED and no cardiac symptoms.
Men (and women) with cardiac disease should be routinely advised on sexual activity as part of a comprehensive approach to rehabilitation. Several therapies are available for the treatment of ED with encouraging significant success rates. There is no evidence that any therapy for ED increases cardiac risk provided the men (and their partners) are properly assessed. Sexual activity is a normal part of life for all age groups and there is no reason why patients with cardiac disease cannot experience a satisfying relationship.
Chapter 28)
