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The importance of risk factor reduction in erectile dysfunction


Erectile dysfunction (ED) is associated with modifiable risk factors. Obesity, physical inactivity, and the metabolic syndrome increase the incidence of ED and markers of low-grade inflammation, which in turn are associated with endothelial dysfunction. Intensive intervention with lifestyle advice focusing on a healthy diet, weight loss, and increased physical activity benefits men with ED and in addition reduces the markers of inflammation and improves endothelial function. Though phosphodiesterase type 5 inhibitors are highly effective in treating ED, lifestyle advice and aggressive risk reduction remain fundamental to the overall vascular good health of the individual.

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References and Recommended Reading

  1. Solomon H, Man JW, Jackson G: Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart 2003, 89:251–253.

    Article  PubMed  CAS  Google Scholar 

  2. Montorsi P, Ravagnani PM, Galli S, et al.: Association between erectile dysfunction and coronary artery disease: matching the right target with the right test in the right patient. Eur Urol 2006, 50:721–731.

    Article  PubMed  Google Scholar 

  3. Jackson G: Erectile dysfunction: a marker of silent coronary artery disease. Eur Heart J 2006, 27:2613–2614.

    Article  PubMed  Google Scholar 

  4. Vlachopoulos C, Aznaouridis K, Ioakeimidis N, et al.: Unfavourable endothelial and inflammatory state in erectile dysfunction patients with or without coronary artery disease. Eur Heart J 2006, 27:2640–2648.

    Article  PubMed  CAS  Google Scholar 

  5. Jackson G, Rosen RC, Kloner RA, Kostis JB: The second Princeton consensus on sexual dysfunction and cardiac risk: new guidelines for sexual medicine. J Sex Med 2006, 3:28–36.

    Article  PubMed  CAS  Google Scholar 

  6. Bacon CG, Mittleman MA, Kawachi I, et al.: A prospective study of risk factors for erectile dysfunction. J Urol 2006, 176:217–221.

    Article  PubMed  Google Scholar 

  7. Blanker MH, Bohnen AM, Groeneveld FP, et al.: Correlates for erectile and ejaculatory dysfunction in older Dutch men: a community-based study. J Am Geriatr Soc 2001, 49:436–442.

    Article  PubMed  CAS  Google Scholar 

  8. Holden CA, McLachlan RI, Pitts M, et al.: Men in Australia Telephone Survey (MATeS) I: a national survey of the reproductive health and concerns of middle aged and older Australian men. Lancet 2005, 366:218–224.

    Article  PubMed  Google Scholar 

  9. Kapelman PG: Obesity as a medical problem. Nature 2000, 404:635–643.

    Google Scholar 

  10. Yudkin JS, Stehouwer CD, Emeis JJ, et al.: C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol 1999, 19:972–978.

    PubMed  CAS  Google Scholar 

  11. Esposito K, Giugliano F, Di Palo C, et al.: Effect of lifestyle changes on erectile dysfunction in men: a randomised controlled trial. JAMA 2004, 291:2978–2984.

    Article  PubMed  CAS  Google Scholar 

  12. Laurmann EO, Nicolosi A, Glasser DB, et al.: Sexual problems among women and men aged 40–80 years: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviour. Int J Impot Res 2005, 17:39–57.

    Article  Google Scholar 

  13. Johannes CB, Araujo AB, Fieldman HA, et al.: Incidence of erectile dysfunction in men aged 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study. J Urol 2000, 163:460–463.

    Article  PubMed  CAS  Google Scholar 

  14. Juenemann KP, Lue TF, Luo JA, et al.: The effect of cigarette smoking on penile erection. J Urol 1987, 138:438–441.

    PubMed  CAS  Google Scholar 

  15. Glina S, Reichet AC, Leao PP, et al.: Impact of cigarette smoking on papaverine-induced erection. J Urol 1988, 140:523–524.

    PubMed  CAS  Google Scholar 

  16. Jackson G: The metabolic syndrome and erectile dysfunction: multiple vascular risk factors and hypogonadism. Eur Urol 2006, 50:426–427.

    Article  PubMed  Google Scholar 

  17. Esposito K, Giugliano F, Margedi E et al.: High proportions of erectile dysfunction in men with the metabolic syndrome. Diabetes Care 2005, 28:1201–1203.

    Article  PubMed  Google Scholar 

  18. Kupelian V, Shabsigh R, Araujo AA, et al.: Erectile dysfunction as a predictor of the metabolic syndrome in aging men: results from the Massachusetts Male Aging Study. J Urol 2006, 176:222–226.

    Article  PubMed  Google Scholar 

  19. Corona G, Mannucci E, Schulmann C, et al.: Psychobiologic correlates of the metabolic syndrome and associated sexual dysfunction. Eur Urol 2006, 50:595–602.

    Article  PubMed  Google Scholar 

  20. Makhsida N, Shah J, Yan G, et al.: Hypogonadism and metabolic syndrome: implications for testosterone therapy. J Urol 2005, 174:827–834.

    Article  PubMed  CAS  Google Scholar 

  21. Esposito K, Ciobola M, Giugliano F, et al.: Mediterranean diet improves erectile function in subjects with the metabolic syndrome. Int J Impot Res 2006, 18:405–410.

    Article  PubMed  CAS  Google Scholar 

  22. Bruckert E, Giral P, Heshmati HM, Turpin G: Men treated with hypolipidaemic drugs complain more frequently of erectile dysfunction. J Clin Pharm Ther 1996, 21:89–94.

    Article  PubMed  CAS  Google Scholar 

  23. Solomon H, Samarasingh YP, Feher MD, et al.: Erectile dysfunction and statin treatment in high cardiovascular risk patients. Int J Clin Pract 2006, 60:141–148.

    Article  PubMed  CAS  Google Scholar 

  24. Hermann HC, Levine LA, Macalusa J, et al.: Can atorvastatin improve the response to sildenafil in men with erectile dysfunction not initially responsive to sildenafil? Hypothesis and pilot trial results. J Sex Med 2006, 3:303–308.

    Article  CAS  Google Scholar 

  25. Solomon H, Wierzbicki AS, Lumb PJ, et al.: Cardiovascular risk factors determine erectile and arterial function response to sildenafil. Am J Hypertens 2006, 19:915–919.

    Article  PubMed  CAS  Google Scholar 

  26. Fogari R, Zoppi A, Polett L, et al.: Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. Am J Hypertens 2001, 14:27–31.

    Article  PubMed  CAS  Google Scholar 

  27. Jackson G: Erectile dysfunction and hypertension. Int J Clin Pract 2002, 56:491–492.

    PubMed  Google Scholar 

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Correspondence to Graham Jackson MD, FRCP.

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Jackson, G. The importance of risk factor reduction in erectile dysfunction. Curr sex health rep 4, 114–117 (2007).

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  • Carve Dilol
  • Valsartan
  • Lifestyle Advice
  • Multiple Vascular Risk Factor
  • Princeton Consensus