The relationship of erectile dysfunction and subclinical cardiovascular disease: A systematic review and meta-analysis

Pathophysiology of erectile dysfunction. These findings appeared to suggest generally favorable outcomes with the use of BoNT-A in the treatment of ED. Based on these conflicting data, a prudent clinician should encourage optimal glycemic control as a potential factor in maintaining erectile function (36,58,59). Account, how does Male Extra work? Rosen RC, Catania J, Pollack L et al:

Men with ED entirely attributed to a psychogenic cause appeared to more frequently experience improved erections and successful intercourse than did men with nonpsychogenic ED (ie, organic ED).

A common problem being uncovered. However, the most common type of drug that may lead to ED is blood pressure medication. Analysis of the efficacy and safety of sildenafil citrate in the geriatric population.

The study was a prospective analysis of 81 patients referred to the department of urology with complaints of ED as well as 35 healthy volunteers; SWE was performed on the corpus cavernosum penis (CCP) in the flaccid state of healthy group. 5-alpha reductase inhibitors (finasteride and dutasteride), the most commonly used drugs to treat benign prostatic hyperplasia, are associated with adverse sexual outcomes, including ED, at rates ranging from 2. For example, as discussed in 4. Randomized, double-blinded, placebo-controlled crossover trial of treating erectile dysfunction with sildenafil after radiotherapy and short-term androgen deprivation therapy:

What were the basic results? 01 microkatals per liter (180 U/L) for women. And with the amount of money that patients shell out for these drugs, we should not be surprised. Treating atherosclerosis with statins may, therefore, lead to a decrease in ED symptoms. Suetomi T, Kawai K, Hinotsu S et al: Rosen R, Shabsigh R, Berber M et al: Studies on this issue in the literature are scarce and available data are conflicting. It is especially a challenge when simple "fixes" do not work.

Data for men with spinal cord injury and men with spina bifida are available only from crossover or fixed-dose trials.


In this study, the authors evaluated 2 groups of patients: A 6-month prospective observational study of primary care practices. In 57% of cases, recovery occurred after withdrawal of statin, implying, somewhat ominously, that recovery did not occur in 43% of cases by the time of reporting. Special offer, if you’re determined to improve your sexual condition, here are a few of the things that you can do to address issues with erectile dysfunction. Efficacy and safety of vardenafil in renal transplant recipients with erectile dysfunction. Am J Hypertens 2020; 14:

0, respectively. These muscle symptoms are typically bilateral and symmetrical and always confined to skeletal muscle. In spite of the overwhelming amount of data linking ED and diabetes, it is often neglected by clinicians treating men with diabetes (39). In penile tissue from diabetic animals, atorvastatin completely restored the diabetes‐induced hypersensitivity to Y‐27632 and prevented RhoA membrane translocation/activation. Avanafil for the treatment of erectile dysfunction:

Injectable alprostadil is administered intracavernosally into one side of the penis. 12% (95% CI, 0. )Some information on the possible mechanisms of these side effects have been obtained, but the intimate mechanism remains uncertain. The clinical significance of this reduction in testosterone with statins is difficult to gauge. Hand-searches included conference proceedings and the authors' files. Personality, 11 Clues to the diagnosis of ED are listed in Table 5 . Researchers believe that statins may work to improve erectile function by helping blood vessels dilate properly and improving vascular blood flow to the penis, which is often restricted in men with erectile dysfunction.

  • Efficacy and safety of vardenafil in men with erectile dysfunction caused by spinal cord injury.
  • One reason erectile dysfunction becomes more common with age is that older men are more likely to be on some kind of medication.
  • One study147 found that higher high-density lipoprotein cholesterol is associated with a lower risk of ischemic stroke, with no effect of total cholesterol or LDL-C; in contrast, higher high-density lipoprotein cholesterol is associated with a higher risk of hemorrhagic stroke, with higher total cholesterol and LDL-C associated with a lower risk.
  • In addition, tadalafil was examined for its ability to cause mechanism-based inhibition of CYP3A-mediated reactions in human liver microsomes.
  • Long-term safety and effectiveness of sildenafil citrate in men with erectile dysfunction.
  • ED may be used to identify patients who may benefit from early screening for vascular dysfunction.
  • 0052), 6 (p = 0.

Where Did The Story Come From?

32 (95% CI, 7. )These relationships remained consistent within age, study quality, methods of assessing ED, and publication year subgroups. J Clin Endocrinol Metab 2020; 94: Another important message was obtained from the French Pharmacovigilance System Database, with which the case/noncase method was used to measure the disproportionality of combinations between statins and ED. Clinical evidence has shown a synergism with sildenafil in poor responders. The efficacy and safety of flexible-dose vardenafil (Levitra) in a broad population of European men. (4; n = 49) and more often reported improved erections with treatment (70% vs 14% for the placebo group). Possible effects of statins on basal and adrenocorticotropic hormone–stimulated cortisol have been examined in several studies, which found no consistent or clinically significant differences between statin and placebo.

8 +/- 1 (baseline) to 12. Jin Z, Zhang ZC, Liu JH et al: Patients who are treated for erectile dysfunction are likely to take additional medications for preexisting conditions such as cardiovascular disease [8]. Asian J Androl 2020; 19: Efficacy and limits of sildenafil citrate in patients with arterial erectile dysfunction: Average maximal voltages and number of stimulations delivered per session were 15 to 18 volts and 15 to 25 stimulations, respectively. Raw food diet: benefits, potential dangers & tips, betaine plays a role in helping fight inflammation while also protecting our internal organs. The only strong genetic association with myopathy involved the SLCO1B1 c.

4 points in men who took statins (from 14. )Wu FC, Tajar A, Beynon JM et al: Effect of atorvastatin on erectile functions in comparison with regular tadalafil use. Healthy living, if there is a post-operative infection, the implant will likely be removed. 94; 95% CI, 0. Statistically significant decreases in TT levels were found in the atorvastatin group but not the simvastatin group. Normal erectile function relies on the coordination of psychologic, neurologic, endocrine, vascular, and muscular factors.

Specially in the patients treated with statins, tadalafil should not be the PDE5 inhibitors of first choice, because of its long half-life [11].


Conditions commonly associated with ED include diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency, and prostate cancer treatment (Table 2). This suggests that the increase in newly diagnosed diabetes mellitus on statin therapy could be somehow mediated by its LDL-C–lowering effect and thus might be shared by inhibitors of PCSK9 (monoclonal antibodies), NPC1L1 (ezetimibe), and HMG-CoA reductase (statins). Algorithm for the diagnosis and management of erectile dysfunction. Psychosocial outcomes after initial treatment of erectile dysfunction with tadalafil once daily, tadalafil on demand or sildenafil citrate on demand:

Use of sildenafil citrate in treatment of Taiwanese men with erectile dysfunction: 5; n = 1836), 85% had at least 1 successful sexual intercourse attempt during treatment (vs 47% for the placebo group; RBI, 1. Early studies suggested a potential benefit on neurogenic ED (NED) from percutaneous electrostimulation of the perineum, although additional studies are needed. Wijitsettakul U and Pempongkosol S: Cimetidine-associated depression and loss of libido in a woman. Comparative trial of treatment satisfaction, efficacy and tolerability of sildenafil versus apomorphine in erectile dysfunction--an open, randomized cross-over study with flexible dosing. However, evidence supporting the association of this or any other polymorphism with myopathy induced by other statins remains limited. Li HJ, Bai WJ, Dai YT et al:

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However, because available results excluded randomized participants not reporting data for a particular outcome, sensitivity analyses were performed for all efficacy outcome measures. The serum melatonin levels, anthropometric data, and other biochemical and hormonal parameters of all the subjects were recorded. A recent comparison of hepatotoxicity during therapy with simvastatin versus atorvastatin using the UK General Practice Research Database yielded higher incidences, but unlike the Swedish study, in which full medical records were available in most cases, only biochemical end points were used, and statin causality was not evaluated. A number of clinical neurophysiological tests have been used in the evaluation of ED.

However, when hypogonadism is clinically suspected but the morning total testosterone level is repeatedly normal, bioavailable testosterone or free testosterone may account for the effects of sex hormone–binding globulin levels on testosterone activity.

A prospective study of risk factors for erectile dysfunction. Medline, Embase, and the Cochrane Library were searched for publications investigating the possible association between ED and Hcy. Azab S, Aoud H and Nabil N: Reply via e-mail at [email protected]

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Zippe CD, Kedia AW, Kedia K et al: Muscle symptoms were the most common reason cited by patients for statin discontinuation (60%), statin nonadherence (52%), and statin switching (33%). (CT)A->L#fr`rkV*O=7SuQ#! A total of 56 patients accepted to undergo assessment for penile vasculature using intracavernosal injection and color Doppler ultrasonography. Counseling is recommended for men with psychogenic ED. Evaluation of patient expectations and treatment satisfaction after 1-year tadalafil therapy for erectile dysfunction: Dahabreh IJ and Paulus JK: Another very important finding from our study is the observation that high LDL-C levels did not interrupt the central response to dorsal penile nerve stimulation, suggesting that hypercholesterolemia (in the absence of significant pudendal artery atherosclerosis) in and of itself is not etiologic for ED.

A double-blind, randomised- placebo, controlled, parallel group, multicentre, flexible-dose escalation study to assess the efficacy and safety of sildenafil administered as required to male outpatients with erectile dysfunction in Korea.

C00DZFO5hcW-6gnt7%4081I&q: Review articles linked fibrates with erectile dysfunction. Muscle symptoms are commonly designated as statin-associated muscle symptoms (SAMS),24 a term that does not indicate or imply a causal relationship between the statin and the symptoms. Daily use of sildenafil improves endothelial function in men with type 2 diabetes. Presented at the American College of Cardiology’s 63rd Annual Scientific Session, this study reviewed 11 clinical trials investigating erectile function in recent years. Other experimental data concerning rosuvastatin, in particular, was investigated by Nangle and colleagues ( 2020 ), who examined the effects of treatment with rosuvastatin on corpus cavernosum and aorta from streptozotocin‐induced diabetic mice in a 4‐week prevention study and a 2‐week intervention study after 4 weeks of untreated diabetes.

BJU Int 2020; 96: Sildenafil citrate (Viagra) in erectile dysfunction: Korean J Urol 2020; 54: 44 per 10 000 patient-years (95% CI, 0. )F8jP_s>Qh`NLq>&: Among the spontaneous reports selected (110 685), exposure to statins was identified in 4471 cases (4%), among which, 51 (1. )

5 inches (90 cm); women ≥ 31.

  • 0 years (1–21 years).
  • 62 A vacuum pump removes air from the tube, pulling blood into the penis and creating an erection.
  • They noted that PESP may be of value in the treatment of patients with NED, provided that further studies are carried out to reproduce these results.
  • There are often long lists of adverse events, particularly in the “Post-marketing Experience” section, which are reports of an adverse event that occurred during treatment, regardless of causality.
  • In contrast to these analyses is the result of a subgroup analysis of data from the longitudinal Fremantle Diabetes Study, an observational cohort study.
  • Instead, the clogged arteries themselves may be the cause.

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Documented injury to perineum/genitalia; or Major pelvic trauma affecting bladder and/or anal and/or erection control; or Major vascular surgery involving aorta or femoral blood vessels; or Neurological disease (eg, diabetic neuropathy); or Peyronie’s disease; or Renal failure; or Secondary to spinal cord injury; or Status-post prostate, bladder, bowel or spinal surgery; or Vascular insufficiency or venous incompetence documented by dynamic infusion cavernosometry and cavernosography (DICC); or Venous leak of the penis. 2`lUeXB-dMla8&,KKuQ"*5\[email protected]%n>EW#! "Efficacy and safety of sildenafil in men with sexual dysfunction and spinal cord injury. D( dff/J4]qeY&rWH3C`4Bu6R`s<5Z*YQW]n39aQV\O#e(OH+Hl,Ek^6SHL. )

For secondary efficacy outcome measures, during the 4 weeks before the end-of-treatment assessment, 83% of men in the sildenafil group reported at least 1 successful sexual intercourse attempt compared with 45% of those receiving placebo (RBI, 1. )The normal range of testosterone is wide [37] and sexual function similar across the range [38]. Maselli G, Bergamasco L, Silvestri V et al:

Shabsigh R, Kaufman J, Magee M et al: Potential subjects were excluded if they were currently using antilipidemics. Insurance coverage varies. Esposito K, Ciotola M, Giugliano F et al:

JAMA Internal Medicine

Validated questionnaires (e. )Peyronie’s disease High cholesterol is an associated risk factor for many of these conditions, and, therefore, it can also increase a person’s likelihood of having ED. 1% in group 1 and 55% in group 2; these frequencies did not reach statistical significance but showed only a trend.

Treatment satisfaction of men and partners following switch from on-demand phosphodiesterase type 5 inhibitor therapy to tadalafil 5 mg once daily. Tests were carried out at 8: Failure to achieve successful intercourse after use of sildenafil may not always have been due to failure of the drug to produce an adequate erection (eg, interruption of sexual activity and drug-associated adverse events).

Ohebshalom M, Parker M, Guhring P et al: Association between erectile dysfunction and coronary artery disease. Side-effect profile of sildenafil citrate (Viagra) in clinical practice. 40 The 80-mg dose of simvastatin is still available for very limited prescription but not recommended except for patients who have taken simvastatin 80 mg/d uneventfully for at least 12 months. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. This meta-analysis also raises the question as to whether lowering testosterone is a side effect of statin therapy or contributes to statins' mode of action, which could inform new treatments and prevention policies. 23,50 It is still unclear why cerivastatin is so much more myotoxic than other statins. Gomery P, Bullock A, McGettigan J et al:

Preliminary observations of sildenafil treatment for erectile dysfunction in dialysis patients.


Golomb found that when patients complained about the most commonly recognized side effects of statins, their doctors denied the possibility of a connection more than half the time. Satisfaction with the treatment, confidence and 'naturalness' in engaging in sexual activity in men with psychogenic erectile dysfunction: Speaking at the European Society of Cardiology (ESC) Congress in Rome, lead researcher Alexios Samantzas from Elpis Hospital in Athens, Greece, said the results were “very significant”. If your doctor prescribes statins to treat high cholesterol, it may not be the medication causing problems.

This difference was statistically significant.

The new trial results allow doctors to reassure their patients that this is not necessarily the case. By lowering cholesterol levels, statins help keep the arteries clear and promote healthy blood flow throughout the body. In general, favorable outcomes have been obtained in all trials so far, although whether SCs had differentiated into specific cell lineages remains controversial.

  • Cq7Vs27SXd bKsoqNi3-( Ybtm+l75!)
  • There is no evidence that statins cause erectile dysfunction.
  • Plasma testosterone is variable, within and between individuals, and has a wide normal range.
  • These researchers treated 10 patients with Peyronie's disease of less than 1 year of evolution twice-weekly during 6 consecutive weeks using iontophoresis with a Miniphysionizer dispositive.
  • 12%, respectively (P=0.)
  • Recent attention related gene therapy to ED cases; this received much interest to further progress gene therapy for the treatment of ED.

International Journal of Impotence Research

Int J Clin Pract 2020; 61: These symptoms occur in people of all types with all levels of education98; there is no implication that the patient is in any way abnormal. They found no difference in cortisol levels between patient and control groups, consistent with our study. The association with ED was statistically significant for all statins (adjusted ROR = 2. )In this dysfunction, there is a change in the NO metabolism in the penile corpus cavernosum, determining a state of arteriolar vasoconstriction, with a reduction of the blood inflow and consequent deficiency in penile erection. But for our men with ED and dyslipidemia, adding atorvastatin to sildenafil can potentially provide both palliation and cure. 7; 95% CI, 29. 132 The relationship between HbA 1c and CVD risk in trials of intensive glucose lowering versus standard therapy is weak.

What Were The Basic Results?

GoodRx is not available outside of the United States. Urology 2020; 61: JAMA 2020; 294: Variable response to intracavernous prostaglandin E1 testing for erectile dysfunction. This underscores the IIEF-5 utility for identifying persons at risk of subclinical CVD. 1 for men allocated to the placebo group (WMD, 1. )

(3%) of 107 835 statin-treated patients were reported as having had a statin-associated adverse event that led to discontinuation of statin therapy. A multicenter, double-blind, placebo-controlled trial to assess the efficacy of sildenafil citrate in men with unrecognized erectile dysfunction. Treatment of erectile dysfunction with sildenafil citrate in renal allograft recipients: For more information, visit www. Statins inhibit the enzyme 3‐hydroxy‐methyl glutaril‐CoA (HMG‐CoA) reductase, which catalyzes the rate‐limiting step in de novo synthesis of cholesterol—that is, the conversion of HMG‐CoA to mevalonate. Segraves RT, Lee J, Stevenson R et al: During rechallenge, patients are likely to believe, quite reasonably, that their symptoms are caused by the statin, especially when they resolve after stopping the statin and then recur on rechallenge.

Buvat J, Hatzichristou D, Maggi M et al: B 33 Phosphodiesterase-5 inhibitors are the first-line treatment for ED. Entertainment, millions of Americans are prescribed statins to prevent heart disease, but some stop taking the medication or take less than the prescribed dose, Kostis said. As part of the Choosing Wisely campaign, the American Urological Association recommends that physicians not prescribe testosterone to men with ED who have normal testosterone levels.

Materials And Methods

Yip WC, Chiang HS, Mendoza JB et al: Patient and partner satisfaction with Viagra (sildenafil citrate) treatment as determined by the erectile dysfunction inventory of treatment satisfaction questionnaire. Nakano Y, Miyake H, Chiba K et al: Vardenafil improved erectile function in a "real-life" broad population study of men with moderate to severe erectile dysfunction in Australia and New Zealand. For the SEP study, stimulus intensity was determined as 2 times sensory threshold. Tadalafil (Cialis) is a potent reversible phosphodiesterase-5 inhibitor used for the treatment of erectile dysfunction.

AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Phosphodiesterase 5 inhibitors for the treatment of erectile dysfunction: 03), with higher risk among those with a history of stroke (1. Efficacy and safety of on-demand tadalafil for the treatment of erectile dysfunction in South-East Asian men. Saigal CS, Wessells H, Pace J et al: Hatzichristou D, Montorsi F, Buvat J et al: Comparable efficacy of once-daily versus on-demand vardenafil in men with mild-to-moderate erectile dysfunction: Consequently, gemfibrozil is rarely used today, whereas there is little if any risk of myopathy/rhabdomyolysis using fenofibrate alone41 or when adding it to a statin.

Zagaja GP, Mhoon DA, Aikens JE et al: Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. They compared tacrolimus 2 to 3 mg daily and placebo in men undergoing RP. 5Bt7#r&0O=Qku! 8 +/- 1 (p < 0. )Data on the efficacy of sildenafil treatment relative to placebo treatment are available for few men with peripheral vascular disease (Table 3). 01 was considered significant for Bonferroni correction analysis. 0001) and shorter total treatment courses (less than 6 weeks, MD:

These Types Of Drugs Can Cause Sexual Problems

Parasympathetic and sympathetic outflow mediates erection. Sharma RK, Prasad N, Gupta A et al: Subsequent data from the HOPE-3 trial in individuals without CVD but at intermediate risk, followed up for a median of 5. Drug-Drug Interactions; 4. Five case reports. The clinical studies of sildenafil for the ageing male. Corona G, Petrone L, Mannucci E et al:

This between-group difference in change from baseline of 1. Impact of penile rehabilitation with low-dose vardenafil on recovery of erectile function in Japanese men following nerve-sparing radical prostatectomy. Early experience with sildenafil for the treatment of erectile dysfunction in renal transplant recipients.

Finally, pretreatment with atorvastatin increased plasma NOx concentrations, sildenafil‐induced hypotension, and tachycardia significantly ( Castro et al, 2020 ).

This included information on myalgia or muscle aching (or muscle-specific events with a similar description) in 12 trials with >100 000 participants along with a meta-analysis of this outcome in these 12 trials. This could then increase the flow of blood to the penis. We also conducted a sensitivity analysis sequentially excluding the three studies that deviated the most from the absolute mean difference (and seen as outliers in the forest plot) in each meta-analysis. A1C, glycated hemoglobin; CV, cardiovascular; CVD, cardiovascular disease; CAD, coronary artery disease; ED, erectile dysfunction; NO, nitrous oxide; PDE5, phosphodiesterase type 5; OSA, obstructive sleep apnea; SHBG, sex hormone-binding globulin. The authors stated that this study has several drawbacks, most notably the small number of studies (n = 9) involved and the lack of a clear definition of ED. There is some evidence that penile SEP may be used to assess integrity of the sensorimotor pathway, which is essential for the maintenance of penile erection during sexual intercourse,32 although the literature is controversial. They stated that future longitudinal studies with uniform patient characteristics are needed to evaluate the potential clinical use of serum biomarkers in men with DM for the development and progression of ED. 36 Men with ED are at higher risk of angina, myocardial infarction, stroke, transient ischemic attack, congestive heart failure, and cardiac arrhythmias compared with men who do not have ED.

He reports having no conflicts of interest.

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The manufacturer sought approval for an original dosage of 5 to 80 mg, but the FDA and other regulatory agencies determined that the 1% risk of myopathy with rosuvastatin 80 mg was too great to support approval of that dose. No significant adverse event (AE) was reported. Muscle toxicity is a potential adverse effect not only for statins, but also with 5PD. In data available from 24 of 27 eligible trials, the combined outcome of angina or chest pain of possible cardiac origin was reported by 0. Antipsychotics are used to treat schizophrenia, bipolar disorder and other serious psychiatric conditions. (GYAbiM6L8=MTH4]^kJH)V&-_G1>'p8`0K! In addition, we assessed whether trial participants and investigators were aware of treatment provided, whether trials used an intention-to-treat analysis, and the percentage of participants who dropped out or were lost to follow-up. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.

1155/2020/858715. 31 These cases were unexpected because animal safety studies had not indicated myotoxicity, although subsequent investigations showed that myopathy could be readily produced in the cyclosporine-treated rat. 59 The injectable form is more effective.


PDE5, phosphodiesterase type 5. Taking a sexual history. The iiEF-5 questionnaire was used to assess ED in patients (Figure 1). You can read more about performance anxiety and ED here.