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Cardiovascular problems often behind erectile dysfunction. (Start with Cardiology Work-Up).

CHICAGO -- Erectile dysfunction flags uncontrolled cardiovascular disease in men.

This maxim and its clinical implications were spelled out in the Princeton Consensus Panel guidelines on erectile dysfunction and cardiovascular disease that were compiled in 1999 and published the following year (Am. J. Cardiology, 86[2]:175-81, 2000).

But despite these guidelines, many men with erectile dysfunction continue to miss out on needed cardiovascular work-ups, Dr. Hemant Solomon said while presenting a poster at the annual scientific sessions of the American Heart Association.

He cited the experience that he and his associates accumulated while assessing 174 men with erectile dysfunction who were originally referred to urologists at Guy's Hospital in London.

None of these men were referred to a cardiologist, despite their high prevalence of cardiovascular disease.

"A man with erectile dysfunction should not be seen by a urologist, but by a cardiologist," according to Dr. Solomon, who is now a cardiologist at Stanford (Calif.) University.

Among these 174 men, aged 25-80 years, 122 (70%) were determined to have a low risk for cardiovascular disease, based on the screening criteria recommended by the Princeton Consensus Panel. Men are considered low risk if they are asymptomatic for cardiovascular disease and have fewer than three risk factors for coronary disease, he said.

Also at low risk are men with controlled hypertension, mild valvular disease, or mild stable angina, as well as those who are at least 6 weeks past an uncomplicated myocardial infarction or successful revascularization procedure.

The remaining 52 men (30%) were determined to have an intermediate or high risk of disease. Intermediate-risk men include those with a more recent myocardial infarction or cerebrovascular event and those with three or more coronary disease risk factors. This group also includes men with a heart murmur of unknown cause or moderate stable angina.

Men are considered at high risk if they have unstable angina, uncontrolled hypertension, moderate or severe valvular disease, a high-risk arrhythmia, or if they have had a myocardial infarction or cerebrovascular event within the past 2 weeks.

Men at low risk of cardiovascular disease can be immediately treated for their erectile dysfunction, including treatment with sildenafil. But men with an intermediate or high risk should have their cardiovascular disease stabilized before receiving treatment for erectile dysfunction, Dr. Solomon said.
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Author:Zoler, Mitchel L.
Publication:Internal Medicine News
Date:Feb 1, 2003
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