[The safety of 5-phosphodiesterase inhibitors in the treatment of erectile dysfunction in patients with cardiovascular disease].

Erectile dysfunction (ED) is a highly prevalent disorder which adversely affects quality of life. The prevalence of erectile dysfunctions affects more than half of the male population over 60 years. Cardiovascular diseases are also highly prevalent conditions and frequently occur concommitantly with ED, mainly because of common several pathophysiological and risk factors. Impressive advances in the management of erectile dysfunction have occurred over the past decade when oral therapy with vasoactive agents has become a first-line treatment. The most widely used class of agents for these kind of disorders is 5-phosphodiesterase inhibitors (5-PDEI). Because the enzyme that they inhibit--PDE-5 is found in smooth muscle cells of the systemic arteries and veins throughout the body, these agents have mild vasodilator effects and thus, have the potential to impact the cardiovascular system. In this article, we review the physiology and the pathophysiology of erection, the influence of 5-PDEI over circulatory system and interactions with drugs commonly used in circulatory disorders. The other purpose of the review (based on the Princeton Consensus I and II) is to present guidelines for safe management of cardiac patients regarding sexual activity and the treatment of ED. We also imply that the recognition of ED is a warning sign of silent vascular disease. Thus a man with ED and no cardiac symptoms may be a cardiac or vascular patient. The conclusion is that, with regard to described rules, PDE-5 inhibitors are safe and effective for the treatment of ED patients with cardiac diseases, including patients with chronic coronary artery disease and hypertension.