Jackson Graham, Rosen Raymond C, Kloner Robert A, Kostis John B
Cardiothoracic Center, St Thomas' Hospital, London, UK.
J Sex Med. 2006 Jan;3(1):28-36; discussion 36. doi: 10.1111/j.1743-6109.2005.00196.x.
Erectile dysfunction (ED) is a highly prevalent disorder associated with a significant burden of illness. The prevalence and incidence of ED are strongly age-related, affecting more than half of men >60 years. The first Princeton Consensus Conference (Princeton I) in 1999 developed guidelines for safe management of cardiac patients regarding sexual activity and the treatment of ED.
The second conference (Princeton II) was convened to update the recommendations based on the expanding knowledge base and new treatments available. This article reviews and expands on the Princeton II guidelines to address sexual dysfunction and cardiac risk.
A consensus panel of experts reviewed recent multinational studies in safety and drug interaction data for three phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil, vardenafil), with emphasis on the safety of these agents in men with ED and concomitant cardiovascular disease.
Erectile dysfunction is an early symptom or harbinger of cardiovascular disease, due to the common risk factors and pathophysiology mediated through endothelial dysfunction. Major comorbidities include diabetes, hypertension, hyperlipidemia and heart disease. Any asymptomatic man who presents with ED that does not have an obvious cause (e.g., trauma) should be screened for vascular disease and have blood glucose, lipids, and blood pressure measurements. Ideally, all patients at risk but asymptomatic for coronary disease should undergo an elective exercise electrocardiogram to facilitate risk stratification. Lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease, is literature-supported.
The recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise. Men with ED and other cardiovascular risk factors (e.g., obesity, sedentary lifestyle) should be counseled in lifestyle modification.
勃起功能障碍(ED)是一种高度普遍的疾病,伴有严重的疾病负担。ED的患病率和发病率与年龄密切相关,60岁以上男性中超过一半受其影响。1999年召开的首次普林斯顿共识会议(普林斯顿I)制定了关于心脏病患者性活动和ED治疗的安全管理指南。
召开第二次会议(普林斯顿II)是为了根据不断扩大的知识基础和可用的新治疗方法更新建议。本文回顾并扩展了普林斯顿II指南,以解决性功能障碍和心脏风险问题。
一个专家共识小组审查了近期关于三种5型磷酸二酯酶(PDE5)抑制剂(西地那非、他达拉非、伐地那非)安全性和药物相互作用数据的多国研究,重点关注这些药物在患有ED和合并心血管疾病男性中的安全性。
勃起功能障碍是心血管疾病的早期症状或先兆,这是由于常见的危险因素和通过内皮功能障碍介导的病理生理学所致。主要合并症包括糖尿病、高血压、高脂血症和心脏病。任何出现无明显病因(如外伤)的ED的无症状男性都应筛查血管疾病,并测量血糖、血脂和血压。理想情况下,所有有冠心病风险但无症状的患者都应接受选择性运动心电图检查,以促进风险分层。ED患者的生活方式干预,特别是体重减轻和增加体育活动,尤其是ED合并心血管疾病的患者,有文献支持。
将ED视为隐匿性血管疾病的警示信号这一认识导致了这样一种观念,即在未被证明无问题之前,患有ED且无心脏症状的男性是心脏病(或血管病)患者。应向患有ED和其他心血管危险因素(如肥胖、久坐不动的生活方式)的男性提供生活方式改变的咨询。