Medications and cardiovascular risk factors

Spurred by recent epidemiologic studies confirming clear associations between cardiovascular risk factors, endothelial dysfunction, and ED, a group of cardiologists, urologists, and other experts from prominent medical centers convened the Second Princeton Consensus Conference to study the risks of sexual activity and adverse drug interactions with PDE-5 inhibitors for men who have, or may have, CVD. The group issued the following valuable recommendations about ED patients with CVD risk factors:

  • Low-risk patients can engage in sex and use PDE-5 inhibitors safely
  • Indeterminate-risk patients require a full cardiac evaluation before they engage in sex
  • High-risk patients are those whose cardiovascular condition precludes engaging in sex until the condition is treated and stabilized

Although the PDE-5 inhibitors are considered safe and highly effective for men with minimal to moderate cardiac disease, including patients taking multiple antihypertensive drugs, it is always best to refer men with high risk factors or any degree of CVD to a cardiologist for evaluation before prescribing a PDE-5 inhibitor or starting any other treatment for a sexual dysfunction. Because ED often indicates an underlying cardiovascular condition, close collaboration between the treating urologist and a cardiologist is greatly beneficial in a substantial number of cases.

Recent studies have demonstrated no significant effect of Cialis on resting coronary blood flow in patients with CAD, but compared to placebo, Cialis significantly increased myocardial blood flow in normal cardiac segments and especially in poorly perfused regions of the cardiac muscles. Furthermore, PDE-5 inhibitors used in conjunction with prostaglandin inhibitors cause vasodilation of the pulmonary artery and reduce pulmonary arterial resistance and hypertension. They can also produce a mild decrease in blood pressure and an increase in the cardiac index and coronary blood flow in animals and humans.