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Kaplan-Meier estimation in different age groups for time to discontinuation of tadalafil OaD treatment. (PDF 109 kb)

Kaplan-Meier estimation in patients stratified according to severity of erectile dysfunction for time to discontinuation of tadalafil OaD treatment. (PDF 118 kb)

Change of IIEF and EDITS total scores from baseline to Month 6 during treatment with tadalafil OaD - subgroup analysis (N = 778; unadjusted data). (PDF 74 kb)

IIEF domain scores at baseline in PDE5 inhibitor-naïve and PDE5 inhibitor pretreated patients (N = 778). (PDF 24 kb)

List of ethical review boards. (PDF 17 kb)

Kaplan-Meier estimation for time to discontinuation of tadalafil OaD treatment. (PDF 102 kb)

An association between erectile dysfunction and cardiovascular disease has long been recognized, and studies suggest that erectile dysfunction is an independent marker of cardiovascular disease risk. Therefore, assessment and management of erectile dysfunction may help identify and reduce the risk of future cardiovascular events, particularly in younger men. The initial erectile dysfunction evaluation should distinguish between predominantly vasculogenic erectile dysfunction and erectile dysfunction of other etiologies. For men believed to have predominantly vasculogenic erectile dysfunction, we recommend that initial cardiovascular risk stratification be based on the Framingham Risk Score. Management of men with erectile dysfunction who are at low risk for cardiovascular disease should focus on risk-factor control; men at high risk, including those with cardiovascular symptoms, should be referred to a cardiologist. Intermediate-risk men should undergo noninvasive evaluation for subclinical atherosclerosis. A growing body of evidence supports the use of emerging prognostic markers to further understand cardiovascular risk in men with erectile dysfunction, but few markers have been prospectively evaluated in this population. In conclusion, we support cardiovascular risk stratification and risk-factor management in all men with vasculogenic erectile dysfunction. (C) 2014 Elsevier Inc. All rights reserved.

Purpose: We established erectile dysfunction as an often neglected but valuable marker of cardiovascular risk, particularly in younger men and men with diabetes. We also reviewed evidence that lifestyle change, combined with informed prescribing of pharmacotherapies used to mitigate cardiovascular risk, can improve overall vascular health and sexual functioning in men with erectile dysfunction. Materials and Methods: We performed a PubMed (R) search for articles and guidelines pertinent to relationships between erectile dysfunction and cardiovascular disease, cardiovascular and all cause mortality, and pharmacotherapies for dyslipidemia and hypertension. The clinical guidance presented incorporates the current literature and the expertise of the multispecialty investigator group. Results: Numerous cardiovascular risk assessment tools exist but risk stratification remains challenging, particularly in patients at low or intermediate short-term risk. Erectile dysfunction has a predictive value for cardiovascular events that is comparable to or better than that of traditional risk factors. Interventional studies support lifestyle changes as a means of improving overall vascular health as well as sexual functioning. Statins, diuretics, beta-blockers and renin-angiotensin system modifiers may positively or negatively affect erectile function. Furthermore, the phosphodiesterase type 5 inhibitors used to treat erectile dysfunction may have systemic vascular benefits. Conclusions: Erectile dysfunction treatment should be considered secondary to decreasing cardiovascular risk. However, informed prescribing may prevent worsening sexual function in men receiving pharmacotherapy for dyslipidemia and hypertension. As the first point of medical contact for men with erectile dysfunction symptoms, the primary care physician or urologist has a unique opportunity to identify those who require early intervention to prevent cardiovascular disease.

The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up. The second objective focused on reevaluation and modification of previous recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD. The Panel’s recommendations build on those developed during the first and second Princeton Consensus Conferences, first emphasizing the use of exercise ability and stress testing to ensure that each man’s cardiovascular health is consistent with the physical demands of sexual activity before prescribing treatment for ED, and second highlighting the link between ED and CVD, which may be asymptomatic and may benefit from cardiovascular risk reduction. (C) 2012 Mayo Foundation for Medical Education and Research Mayo Clin Proc. 2012;87(8):766-778

Centre Etude et de Traitement de la Pathologie de l’Appareil Reproducteur et de la Psychosomatique (ETPARP). Lille, France Pfizer Inc. New York. New York, USA Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Unidade de Epidemiologia e Bioestatística. Salvador, BA, Brasil Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Unidade de Epidemiologia e Bioestatística. Salvador, BA, Brasil Bristol Urological Institute. Southmead Hospital. Bristol, UK Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Unidade de Epidemiologia e Bioestatística. Salvador, BA, Brasil Global Study of Sexual Attitudes and Behaviours (GSSAB) Investigators’ Group OBJECTIVES: To report the sexual activity, the prevalence of sexual problems and related help-seeking behavior among adults in France. METHODS: A telephone survey was conducted in 2001 and 2002. Interviews were based on a standardized questionnaire including demographic details, overall health, relationships, and sexual behaviors, attitudes and beliefs. RESULTS: A total of 1500 individuals (750 men, 750 women) aged 40 to 80 years completed the survey. Eighty-one percent of men and 65% of women had engaged in sexual intercourse during the 12 months preceding the interview. Premature ejaculation (16%) and erectile dysfunction (15%) were the most frequently reported sexual problems among men. Lack of sexual interest (21%) and a lack of sexual pleasure (18%) were the most frequently reported ones among women. Only 10% of men and 8% of women had been asked by a doctor about possible sexual problems during a routine visit in the last 3 years. CONCLUSIONS: Many middle aged and older men and women in France report continued sexual interest and activity. Although a number of sexual problems are seen in this population, only a minority of individuals seek medical help for these disorders. This is largely due to believing that the problem is not serious, not being bothered by the problem, and/or a lack of awareness of available treatments