Cardiovascular risk factors and erectile dysfunction

Vascular disease plays an important-role in erectile dysfunction (ED) and is reported to result in a significant increase in impotence in later life. The introduction of the drug sildenafil has led many men to seek prescriptions, which in turn has resulted in their evaluation by physicians who have found a variety of serious, untreated medical conditions. The use of cardiac drugs increases the occurrence of ED, with thiazide diuretic usage correlating most closely. Most of the deaths reported since sildenafil went on the market in late March 1998 have been cardiac related. Careful cardiac evaluation, which may include exercise stress testing, should be considered before sildenafil is prescribed, especially for older, physically and/or sexually inactive men with known coronary artery disease or multiple risk factors for it.