The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
The Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada.
J Sex Med. 2017 Dec;14(12):1597-1605. doi: 10.1016/j.jsxm.2017.10.063.
Erectile dysfunction (ED) can be a sentinel marker for future cardiovascular disease and has been described as providing a "window of curability" for men to receive targeted cardiovascular risk assessment.
To determine whether the prescription of phosphodiesterase type 5 inhibitors (PDE5is) for ED leads to the detection and treatment of previously undiagnosed cardiometabolic risk factors.
We performed a retrospective population-based cohort study of residents of British Columbia, Canada using linked health care databases from 2004 to 2011. An individual-level time series analysis with switching replications was used to determine changes in drug use for hypertension, hypercholesterolemia, and diabetes in men 40 to 59 years old. The observation window for each patient was 720 days before and 360 days after the index date.
The primary outcome was changes in prescriptions for antihypertensive, statin, and oral antidiabetic drugs, with secondary outcomes being laboratory tests for plasma cholesterol and glucose.
5,858 men 40 to 59 years old newly prescribed a PDE5i were included in the analysis. We found a sudden increase in prescriptions for antihypertensive drugs (40 per 1,000; P < .001), statins (10 per 1,000; P = .001), and antidiabetic drugs (17 per 1,000; P = .002) in the 90 days after a new prescription for a PDE5i. For hypercholesterolemia and diabetes, most of this change was observed in men with relevant screening tests performed in the 30 days after their PDE5i prescription. Only 15% and 17% of men who did not have a screening test for cholesterol and glucose, respectively, in the year before their PDE5i prescription went on to have one in the subsequent 30 days.
The paucity of screening tests observed in our study after PDE5i prescriptions suggests that physicians should be educated on the recommended screening guidelines for men newly diagnosed with ED.
The number of men who were ordered a laboratory test or written a prescription but chose not to complete or fill it, respectively, is unknown.
Treatment for ED with PDE5is can be a trigger or "gateway drug" for the early detection and treatment of cardiometabolic risk factors provided physicians perform the requisite screening investigations. Skeldon SC, Cheng L, Morgan SG, et al. Erectile Dysfunction Medications and Treatment for Cardiometabolic Risk Factors: A Pharmacoepidemiologic Study. J Sex Med 2017;14:1597-1605.
勃起功能障碍（ED）可能是未来心血管疾病的一个哨兵标志物，并被描述为提供了一个“可治愈窗口”，使男性能够接受有针对性的心血管风险评估。
确定为 ED 开具磷酸二酯酶 5 抑制剂（PDE5i）是否会导致检测和治疗以前未诊断出的心血管代谢危险因素。
我们使用 2004 年至 2011 年不列颠哥伦比亚省居民的链接医疗保健数据库，进行了一项基于人群的回顾性队列研究。使用切换复制的个体水平时间序列分析来确定 40 至 59 岁男性高血压、高胆固醇血症和糖尿病药物使用的变化。每位患者的观察窗口为索引日期前 720 天和后 360 天。
共纳入 5858 名 40 至 59 岁新处方 PDE5i 的男性。我们发现，新处方 PDE5i 后 90 天内，抗高血压药物（每 1000 人增加 40 人；P<.001）、他汀类药物（每 1000 人增加 10 人；P=.001）和口服抗糖尿病药物（每 1000 人增加 17 人；P=.002）的处方突然增加。对于高胆固醇血症和糖尿病，在 PDE5i 处方后 30 天内进行相关筛查测试的男性中观察到大部分变化。在 PDE5i 处方前一年内没有进行胆固醇和葡萄糖筛查测试的男性中，只有 15%和 17%分别在随后的 30 天内进行了一次筛查测试。
在 PDE5i 处方后观察到的筛查测试数量很少，这表明应教育医生新诊断为 ED 的男性有关推荐的筛查指南。
不知道有多少人被开了实验室检查或开了处方但分别选择不完成或不填写。
用 PDE5i 治疗 ED 可以作为早期检测和治疗心血管代谢危险因素的触发因素或“入门药物”，前提是医生进行必要的筛查调查。
