The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

doi:10.1016/j.mayocp.2012.06.015

Mayo Clinic Proceedings

Volume 87, Issue 8, August 2012, Pages 766-778

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https://doi.org/10.1016/j.mayocp.2012.06.015 Get rights and content

Abstract

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.

Section snippets

Recommendations

The recommendations of the third Princeton Consensus Conference focus on (1) evaluation and management of cardiovascular risk in men with ED and no known CVD, (2) reevaluation and modification of the second conference recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD, and (3) the role of TRT in ED and CVD management.

Evaluation and Management of Cardiovascular Risk in the Patient With ED With No Known CVD

The consensus panel defines cardiovascular risk as the risk of morbid events over a 3- to 5-year interval from the onset of ED (American College of Cardiology Foundation/American Heart Association [ACCF/AHA] class Ib)3, 4 and provides recommendations for the evaluation and management of cardiovascular risk in men with ED and no known CVD. The panel's approach broadens the use of the 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults to address an at-risk

Management of ED in the Patient With Known CVD

The objective of this algorithm is to estimate the cardiovascular risk associated with sexual activity in patients with ED and known CVD (Figure). Herein, risk refers to the likelihood of mortal or morbid events during or shortly after sexual activity. The panel's recommendations are similar to those developed during the first and second Princeton Consensus Conferences.1, 2 However, the current recommendations classify patients with New York Heart Association (NYHA) class II as low risk rather

Recommendations

Consistent with other guidelines, the recommendations of the third Princeton Consensus Panel emphasize an approach to risk assessment that integrates multiple aspects of cardiometabolic health. Sexual function should be incorporated into CVD risk assessment for all men, and ED may allow identification of at-risk men who require further cardiovascular evaluation. The scientific evidence suggests that a comprehensive approach to cardiovascular risk reduction will improve overall vascular health,

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Sexual Health and Well-Being in Adults With Congenital Heart Disease: A International Society of Adult Congenital Heart Disease Statement
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As health care outcomes improve the priority for those living with adult congenital heart disease have changed to a more holistic focus on quality of life and well-being. Although health care has embraced this, there are still areas where there is a deficit in advice, allyship, and advocacy. One of these deficits is in the area of sexual health and well-being. A healthy sexual life has a myriad of physical and psychosocial benefits. However, individuals with adult congenital heart disease may have significant barriers to achieving well-being in this aspect of their lives. These barriers and their potential solutions are outlined in this paper.
Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion
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It is the responsibility of the clinician to assess for the presence of erectile dysfunction, ejaculatory dysfunction, or diminished libido in men presenting for evaluation of infertility. Referral to a reproductive urologist or other appropriate specialist with the requisite expertise in the evaluation and treatment of such conditions, including appropriate treatment of testosterone deficiency, is often warranted. This article replaces the article of the same name, last published in 2018.
Evaluación diagnóstica de la disfunción sexual en la pareja masculina en el contexto de la infertilidad: opinión del comité
Es responsabilidad del médico evaluar la presencia de disfunción eréctil, disfunción eyaculatoria o disminución de la libido en hombres que se presentan para la evaluación de infertilidad. A menudo se justifica la derivación a un urólogo reproductivo u otro especialista apropiado con la experiencia necesaria en la evaluación y el tratamiento de estas condiciones, incluido el tratamiento adecuado de la deficiencia de testosterona. Este artículo reemplaza el artículo del mismo nombre, publicado por última vez en 2018.
Erectile Dysfunction Is Associated with Left Ventricular Diastolic Dysfunction: A Systematic Review and Meta-analysis
2023, European Urology Focus
Erectile dysfunction (ED) is associated with an increased risk of cardiovascular morbidity and mortality.
To systematically review and analyze the cardiac structure and function in men with ED assessed with echocardiography.
We performed a systematic review and meta-analysis according to the guideline of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched PubMed and the Cochrane Library on June 2, 2022, and included studies evaluating cardiac structure and function using echocardiography in men with ED compared with controls without ED. The Newcastle-Ottawa Quality Assessment Scale was used for assessing the quality of studies. We analyzed the mean differences in left ventricular ejection fraction (LVEF), the ratio of early transmitral filling velocity to early diastolic mitral annular velocity (E/e′), ratio of the early to late diastolic transmitral flow velocity (E/A), isovolumic relaxation time (IVRT), and left ventricular mass index (LVMi) in a random-effect model computed using means and standard deviations. The review was preregistered with PROSPERO (CRD42022337183). We received no funding.
We included ten studies with 763 men diagnosed with ED (mean age: 55.6 yr) and 358 control men (mean age: 54.4 yr). E/e′ was significantly worse in men with ED than in controls (mean absolute difference = 1.17, 95% confidence interval or CI [0.68, 1.65], p < 0.005). No significant differences were observed in LVEF, E/A, IVRT, or LVMi (–0.06, 95% CI [–1.06, 0.95], p = 0.91; –0.06, 95% CI [–0.24, 0.13], p = 0.55; 11.76, 95% CI [–0.88, 24.39], p = 0.07; and 4.37, 95% CI [–2.91, 11.65], respectively). The studies exhibited heterogeneity regarding study populations, reported echocardiography data, and variations in adjustments for confounding factors.
Left ventricle diastolic dysfunction, as assessed by E/e′, was more frequent in men with ED than in matched controls without ED. The results imply that echocardiography may be useful in the cardiovascular evaluation of men with ED to help identify myocardial impairment.
This study reviewed for the first time previous research on cardiac structure and function in men with erectile dysfunction (ED), as assessed by echocardiography. We found that men with ED, compared with men without ED, had a higher ratio of early transmitral filling velocity to early diastolic mitral annular velocity , indicating a potentially higher rate of impaired diastolic function—a potential early indicator of heart disease. Identification of early signs of heart problems in men with ED may help initiate necessary lifestyle modifications or preventative therapies before the development of heart disease. However, more research is required to determine the clinical utility of using echocardiography as a risk assessment method.
New developments in the treatment of erectile dysfunction
2023, FMC Formacion Medica Continuada en Atencion Primaria
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  Existen cada vez más evidencias sobre la relación de la disfunción eréctil (DE) y la enfermedad cardiovascular (ECV), ya que podría ser una manifestación temprana de enfermedad arterial coronaria y vascular periférica.
- •
  La evaluación de las opciones de tratamiento debe adaptarse según la satisfacción del paciente y la pareja, los factores de calidad de vida, seguridad, eficacia y características invasivas de cada técnica terapéutica.
Male sexual dysfunction
2023, Penn Clinical Manual of Urology, Third Edition
The topic of male sexual dysfunction is quite broad and includes many different areas of male sexuality. This includes the diagnosis and treatment of erectile function and dysfunction, male hypogonadism, ejaculation and ejaculation disorders, as well as the diagnosis and treatment of Peyronie’s disease.
This chapter reviews the prevalence of male sexual dysfunction. We note that premature ejaculation is the most common sexual malady in younger men, while erectile dysfunction is the most common sexual issue in older men
The treatment options for male erectile dysfunction include PDE5 inhibitor therapy, vacuum erection device therapy, intracavernosal penile injections, penile prosthesis or psychotherapy as indicated.
Penile shockwave therapy, as well as injection of plasma-rich protein into the penis are considered experimental.
Peyronie’s disease is diagnosed by history combined with a physical exam. It is prudent to perform an intracavernosal injection of PGE1 in the office to see the extent of the curvature and palpate the plaque. It is important to measure penile length in both the flaccid state as well as the erect state.
Treatment options include conservative therapy, intralesional injection of clostridium collagenase, vacuum therapy, penile traction, or surgical options. Vacuum therapy and traction device therapy are not well-studied. Surgery includes penile prosthesis insertion for those with both Peyronie’s and erectile dysfunction. Surgical procedures to correct the curvature in men with reasonable erectile function. This operation includes penile shortening as an outcome, as a consequence of the plication procedure.
For those patients who wish to maintain penile length, operations include placement of a graft into the excised penile plaque, or plaque incision with placement of a graft. Both procedures carry a small risk of penile shortening.
Premature ejaculation is common in younger men. Treatment includes topical therapies, oral therapies, combined with psychosexual therapy.
Delayed ejaculation is often geared toward treating the inciting cause.
Male hypogonadism is diagnosed by a high index of suspicion combined with checking serum testosterone levels via blood test. There were a variety of. FDA -cleared treatments for male hypogonadism, including T injections, gels and patches, oral pills, nasal spray, as well as a buccal preparation. Testosterone therapy in elderly men carries the potential risk of cardiovascular events (i.e., DVT, stroke, MI).
PDE5 inhibitors, specifically 5mg of Cialis, can be used as daily therapy for men with BPH/LUTS.
Sexual problems in diabetes
2022, Medicine (United Kingdom)
Diabetes mellitus causes sexual dysfunctions via autonomic neuropathy and endothelial dysfunction in the genitals, and via its effects as a chronic disease on the individual’s global health and well-being. The most commonly complained of sexual dysfunction associated with diabetes is erectile dysfunction (ED), experienced by 35–90% of men with diabetes. It is increasingly recognized that the multiple factors causing ED in men also affect sexual function in women. In a recent study, 44% of women with type 1 diabetes and 25% with type 2 diabetes had a sexual dysfunction, but diabetic women complain of problems with sex much less often than diabetic men. The success of Viagra brought ED into the social and medical limelight; loss of arousal and therefore desire in women is a more multifactorial, and less visible, problem.

View all citing articles on Scopus

: Dr Nehra is now with the Department of Urology, Rush University Medical Center, Chicago, IL. Dr Billups is now with the James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD.

: Potential Competing Interests: Dr Jackson is a speaker for Pfizer, New York, NY, Eli Lilly & Co, Indianapolis, IN, and Bayer, Leverkusen, Germany. Dr Miner is a consultant to Eli Lilly & Co, Abbott Laboratories, Chicago, IL, Auxilium Pharmaceuticals Inc, Malvern, PA, Boehringer Ingelheim, Ingelheim, Germany, and Endo Pharmaceuticals, Chadds Ford, PA, and conducts personal research for GlaxoSmithKline, London, UK, and Auxilium Pharmaceuticals Inc.

: Dr Billups is a consultant to Endo Pharmaceuticals and Abbott Laboratories.

: Dr Burnett is a consultant to Endo Pharmaceuticals, Abbott Laboratories, Timm Medical Technologies, Eden Prairie, MN, VIVUS Inc, Mountain View, CA, Auxilium Pharmaceuticals Inc, and Shionogi Inc, Florham Park, NJ; has received grant support from Pfizer; and has participated in clinical trials for VIVUS Inc and Auxilium Pharmaceuticals Inc.

: Dr Buvat is a consultant to Eli Lilly & Co and Nextmed, Tucson, AZ.

: Dr Carson is a consultant to and a speaker for GlaxoSmithKline, Eli Lilly & Co, Pfizer, and Auxilium Pharmaceuticals Inc.

: Dr Cunningham is a consultant to Abbott Laboratories, Endo Pharmaceuticals, and GlaxoSmithKline and is a speaker for Abbott Laboratories, Endo Pharmaceuticals, and Merck, Whitehouse Station, NJ.

: Dr Ganz is a consultant to Pfizer, Gilead, Forest City, CA, and Roche, Basel, Switzerland.

: Dr Goldstein is a consultant to Coloplast, Humlebæk, Denmark, Medtronic Vascular, Fridley, MN, Slate, and VIVUS Inc; a speaker for Abbott Laboratories, Auxilium Pharmaceuticals Inc, Coloplast, Eli Lilly & Co, Endo Pharmaceuticals, Medtronic Vascular, and Slate Pharmaceuticals, Lake Forest, IL, performs personal research for Auxilium Pharmaceuticals Inc, BioSante Pharmaceuticals, Lincolnshire, IL, Medtronic Vascular, Slate, and Target Health, New York, NY; and is an expert witness for Pfizer and Bayer.

: Dr Guay is a consultant to Auxilium Pharmaceuticals Inc, Abbott Laboratories, Endo Pharmaceuticals, and Repros Therapeutics, The Woodlands, TX.

: Dr Hackett is a speaker and conducts personal research for Bayer and Eli Lilly & Co.

: Dr Kloner is a speaker for Pfizer.

: Dr Kostis is a consultant to Merck/Schering and Palatin Technologies Inc, Cranbury, NJ; a speaker for Forest Laboratories, New York, NY, Merck, and Sanofi-Aventis; and has received research support from Medtronic and Novartis, Basel, Switzerland.

: Dr Rosen is a consultant to Eli Lilly & Co, Boehringer Ingelheim, Palatin Technologies Inc, and Auxilium Pharmaceuticals Inc.

: Dr Sadovsky is a consultant to Pfizer, Boehringer Ingelheim, and Eli Lilly & Co.

: Dr Seftel is a consultant to Auxilium Pharmaceuticals Inc, Endo Pharmaceuticals, Actient, Abbott Laboratories, Eli Lilly & Co, and Pfizer.

: Dr Vlachopoulos is a consultant to Eli Lilly & Co and has received research support from Pfizer.

: Dr Wu is a consultant to Eli Lilly & Co, is a speaker for Galapagos NV, Mechelen, Belgiu, and conducts personal research for Bayer.

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Diagnosis and treatment guidelinesThe Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

Abstract

Section snippets

Recommendations

Evaluation and Management of Cardiovascular Risk in the Patient With ED With No Known CVD

Management of ED in the Patient With Known CVD

Recommendations

Am J Cardiol

Am J Cardiol

Eur Urol

J Urol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Sex Med

Am J Cardiol

Eur Urol

Atherosclerosis

Eur Urol

Mayo Clin Proc

J Sex Med

Am J Cardiol

J Sex Med

J Clin Epidemiol

Clin Cornerstone

Kidney Int

Eur Urol

Endocr Pract

J Sex Med

J Sex Med

J Sex Med

J Sex Med

Eur Urol

J Sex Med

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

The temporal relationship between erectile dysfunction and cardiovascular disease

Int J Clin Pract

2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

Circulation

Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus

Int J Clin Pract

Profile of men randomized to the prostate cancer prevention trial: baseline health-related quality of life, urinary and sexual functioning, and health behaviors

J Clin Oncol

Should erectile dysfunction be considered as a marker for acute myocardial infarction?results from a retrospective cohort study

Int J Impot Res

Circulation

Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: results from the Krimpen Study

Int J Impot Res

Erectile dysfunction and subsequent cardiovascular disease

JAMA

Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients

Circulation

Association between erectile dysfunction and coronary artery disease: role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial

Eur Heart J

Distribution of 10-year and lifetime predicted risks for cardiovascular disease in US adults: findings from the National Health and Nutrition Examination Survey 2003 to 2006

Circ Cardiovasc Qual Outcomes

Erectile dysfunction is a marker for cardiovascular disease: results of the Minority Health Institute Expert Advisory Panel

J Sex Med

Does severity of ischemic coronary disease correlate with erectile function?

Int J Impot Res

The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis

Arch Intern Med

Prediction of coronary heart disease using risk factor categories

Circulation

Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study

Arch Intern Med

Comparing trends in BMI and waist circumference

Obesity (Silver Spring)

Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies

Lancet

Diagnosis and treatment guidelines
The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease