Erectile dysfunction in cardiac patients (part 2)

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Erectile dysfunction: There is an assumption that about 50% of ED cases in men over 50 years of age are the result of vascular diseases. A significant part of them may be related to the END. Experimental studies conducted on rabbits have shown that END can lead to ED even before the development of atherosclerotic stenoses that interfere with blood flow in the arteries that supply blood to the cavernous bodies. Azadzoi et al. the rabbits were fed food with a high cholesterol content or normal food for them. They then induced an erection in the rabbits by intra-cavernous administration of drugs such as phentolamine. Rabbits that received normal nutrition were able to achieve and maintain an erection with increased intracavernous pressure. Rabbits on a high-cholesterol diet were not able to maintain an erection, which was confirmed by a decrease in intracavernous pressure. ED also occurred in rabbits that developed angiographic-detectable arterial stenosis, but the most important was the detection of ED in rabbits that presumably developed END as a result of high blood cholesterol, even before the formation of atherosclerotic constrictions.

Many studies have shown that risk factors for CHD and hypertension are also risk factors for Erectile dysfunction. This is important because these risk factors lead to the development of END in the entire vascular system. With its development, atherosclerosis affects various vascular channels. Disorders of lipid metabolism, especially low high-density lipoprotein cholesterol and high total cholesterol, diabetes, smoking, and hypertension (known as CHD risk factors) are proven risk factors for ED. Obesity and low physical activity are also risk factors for ED. Thus, patients with heart disease or who have risk factors for CHD are more likely to develop ED, and they should be asked questions about the state of their erectile function. On the other hand, in some cases, patients turn to doctors in search of treatment for ED. It is important to ask such patients questions about cardiovascular risk factors: do they suffer from hypertension, disorders of lipid metabolism, diabetes? Do they smoke? If such risk factors can be identified and cured, doctors can save the lives of many patients.

Erectile dysfunction

Although ED is often associated with many cardiovascular risk factors, it is widely known that most cardiologists do not ask their patients questions about sexual disorders. The same is true in other medical specialties, including urologists. Kloner et al. we conducted a pilot study in collaboration with a large private cardiology center in Los Angeles to determine the prevalence of ED in men with stable chronic coronary heart disease. The study included 66 patients with proven CHD, many of whom had previously undergone surgical treatment (balloon dilation with or without stenting or aorto-coronary bypass surgery). Usually, patients answered the questionnaire questions while waiting for an appointment or at home, sending the answers by mail. This questionnaire, which is an abbreviated version of IIEF, contains 5 questions that determine a man’s ability to achieve and maintain an erection. All questions were rated from 0 to 5 points, and the results were summed up. A result less than or equal to 21 was considered as a sign of ED. 75% of men had ED. In addition, 25% of men with ED suffered from severe ED. Thus, ED often accompanies CHD. Similar results were observed in patients with hypertension (regardless of taking antihypertensive drugs).

Erectile dysfunction as a prognostic factor of CHD development

The results of several studies suggest that patients with ED, even if they do not suffer from angina and do not have a history of heart attacks, are more likely to show signs of myocardial ischemia during exercise tests. They are also highly likely to have risk factors for ED. In this connection, Pritzker proposed the term “penile stress test”. In other words, the development of ED may be an early sign of the presence of other risk factors for CHD in men.

ED and Viagra

Viagra works by inhibiting the enzyme PDE-5, which breaks down cyclic guanosine monophosphate. It leads to the relaxation of smooth muscle cells of the arteries, arterioles and sinusoids in the cavernous body of the penis. NO released by the adrenergic cholinergic nerve endings and endothelium during sexual stimulation leads to the activation of the enzyme guanylate cyclase, which catalyzes the formation of the enzyme. Its amount may be insufficient in men with ED. Thus, the PDE–5 inhibitor Viagra prevents the breakdown of this enzyme, which leads to greater vasodilation in the cavernous bodies and a better erection.

Taking 100mg of viagra leads to an improvement in erection in 82% of patients with ED. The drug is effective in patients with organic and psychogenic ED. In patients with ED and CHD (and presumably atherosclerotic or vascular causes of ED), viagra was effective in about 70% of cases.

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