Kloner R, Padma-Nathan H
Heart Institute, Good Samaritan Hospital (USC), Los Angeles, CA 90017, USA.
Int J Impot Res. 2005 May-Jun;17(3):209-15. doi: 10.1038/sj.ijir.3901309.
Recent studies suggest that erectile dysfunction (ED) may be an early marker of endothelial dysfunction and coronary artery disease (CAD). Conversely, patients with CAD commonly have ED. The phosphodiesterase 5 (PDE5) inhibitors are very effective for the treatment of ED in patients with CAD. Numerous studies show that this class of drugs is in general safe in patients with stable CAD and these agents do not exacerbate ischemia in men with CAD undergoing exercise stress testing. Analysis of placebo-controlled trials did not show an increase in cardiovascular events among men receiving PDE5 inhibitors, and post-marketing surveillance studies with sildenafil did not observe an increase in cardiovascular events compared to expected age-matched rates. Organic nitrates remain a contraindication for PDE5 inhibitors and alpha blockers have precautions/contraindications depending upon specific drugs. The Princeton Consensus Guidelines (soon to be updated) suggest a logical approach to the patient with CAD seeking therapy for sexual dysfunction.
近期研究表明，勃起功能障碍（ED）可能是内皮功能障碍和冠状动脉疾病（CAD）的早期标志。相反，CAD患者通常患有ED。磷酸二酯酶5（PDE5）抑制剂对CAD患者的ED治疗非常有效。大量研究表明，这类药物对稳定型CAD患者总体安全，且这些药物不会加重接受运动应激试验的CAD男性患者的缺血情况。安慰剂对照试验分析显示，接受PDE5抑制剂的男性心血管事件并未增加，与西地那非相关的上市后监测研究也未观察到心血管事件发生率高于预期年龄匹配率。有机硝酸盐仍然是PDE5抑制剂的禁忌证，α受体阻滞剂根据具体药物有相应的注意事项/禁忌证。普林斯顿共识指南（即将更新）为寻求性功能障碍治疗的CAD患者提出了一种合理的治疗方法。
