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Heart 89:251-253 doi:10.1136/heart.89.3.251
  • Review

Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator

Table 1

Recommendations for management of erectile dysfunction based on graded cardiovascular risk assessment

Grading of risk Cardiovascular status on presentation Management recommendations for the primary care physician
Reproduced from Jackson and colleagues27 with permission. CAD, coronary artery disease; CHF, congestive heart failure; LVD, left ventricular dysfunction; NYHA, New York Heart Association; SBP, systolic blood pressure.
Low risk

  • Asymptomatic, <3 major risk factors for CAD, excluding age and sex

  • Controlled hypertension

  • Mild stable angina

  • Successful coronary revascularisation

  • Mild valve disease

  • LVD/CHF (NYHA class I)

  • Provide primary care management

  • Review treatment options with patient and his partner (where possible)
Intermediate risk

  • >3 major risk factors for CAD, excluding age and sex

  • Moderate stable angina

  • Recent myocardial infarction or cardiovascular event (<6 weeks)

  • LVD/CHF (NYHA class II)

  • Murmur of unknown cause

  • Conduct a specialised evaluation (for example, exercise treadmill test for angina, echocardiography for murmur)

  • Place patient into high or low risk category, depending on outcome of testing
High risk

  • Unstable or refractory angina

  • Uncontrolled hypertension (SBP >180 mm Hg)

  • CHF (NYHA class III, IV)

  • Recent myocardial infarction or cardiovascular event (<2 weeks)

  • High risk arrhythmias

  • Hypertrophic obstructive and other cardiomyopathies

  • Moderate/severe valve disease

  • Refer for specialised cardiac evaluation and management

  • Defer treatment for erectile dysfunction until cardiac condition stabilised or specialist evaluation completed

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