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

Overview

Journal Mayo Clin Proc

Specialty General Medicine

Date 2012 Aug 7

PMID 22862865

Citations 107

Authors

Ajay Nehra

Graham Jackson

Martin Miner

Kevin L Billups

Arthur L Burnett

Jacques Buvat

Culley C Carson

Glenn R Cunningham

Peter Ganz

Irwin Goldstein

Andre T Guay

Geoff Hackett

Robert A Kloner

John Kostis

Piero Montorsi

Melinda Ramsey

Raymond Rosen

Richard Sadovsky

Allen D Seftel

Ridwan Shabsigh

Charalambos Vlachopoulos

Frederick C W Wu

Affiliations

Soon will be listed here.

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.

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References

Mozaffarian D, Wilson P, Kannel W . Beyond established and novel risk factors: lifestyle risk factors for cardiovascular disease. Circulation. 2008; 117(23):3031-8. DOI: 10.1161/CIRCULATIONAHA.107.738732. View

Gupta B, Murad M, Clifton M, Prokop L, Nehra A, Kopecky S . The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med. 2011; 171(20):1797-803. DOI: 10.1001/archinternmed.2011.440. View

Kapoor D, Aldred H, Clark S, Channer K, Jones T . Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care. 2007; 30(4):911-7. DOI: 10.2337/dc06-1426. View

Bray G, Clearfield M, Fintel D, Nelinson D . Overweight and obesity: the pathogenesis of cardiometabolic risk. Clin Cornerstone. 2009; 9(4):30-40. DOI: 10.1016/s1098-3597(09)80003-3. View

Wilson P, DAgostino R, Levy D, Belanger A, Silbershatz H, Kannel W . Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97(18):1837-47. DOI: 10.1161/01.cir.97.18.1837. View

Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, DAndrea F . Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004; 291(24):2978-84. DOI: 10.1001/jama.291.24.2978. View

Inman B, St Sauver J, Jacobson D, McGree M, Nehra A, Lieber M . A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc. 2009; 84(2):108-13. PMC: 2664580. DOI: 10.4065/84.2.108. View

Doumas M, Tsakiris A, Douma S, Grigorakis A, Papadopoulos A, Hounta A . Beneficial effects of switching from beta-blockers to nebivolol on the erectile function of hypertensive patients. Asian J Androl. 2006; 8(2):177-82. DOI: 10.1111/j.1745-7262.2006.00076.x. View

Jackson G, Padley S . Erectile dysfunction and silent coronary artery disease: abnormal computed tomography coronary angiogram in the presence of normal exercise ECGs. Int J Clin Pract. 2008; 62(6):973-6. DOI: 10.1111/j.1742-1241.2008.01788.x. View

10.

Thompson I, Tangen C, Goodman P, Probstfield J, Moinpour C, Coltman C . Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2006; 294(23):2996-3002. DOI: 10.1001/jama.294.23.2996. View

11.

Critchley J, Capewell S . Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003; 290(1):86-97. DOI: 10.1001/jama.290.1.86. View

12.

Guay A, Velasquez E, Perez J . Characterization of patients in a medical endocrine-based center for male sexual dysfunction. Endocr Pract. 2004; 5(6):314-21. DOI: 10.4158/EP.5.6.314. View

13.

Dadkhah F, Safarinejad M, Asgari M, Hosseini S, Lashay A, Amini E . Atorvastatin improves the response to sildenafil in hypercholesterolemic men with erectile dysfunction not initially responsive to sildenafil. Int J Impot Res. 2009; 22(1):51-60. DOI: 10.1038/ijir.2009.48. View

14.

Thompson P, Buchner D, Pina I, Balady G, Williams M, Marcus B . Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition,.... Circulation. 2003; 107(24):3109-16. DOI: 10.1161/01.CIR.0000075572.40158.77. View

15.

Murray G, Butcher I, Heald C, Lee R, Chambless L, Folsom A . Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008; 300(2):197-208. PMC: 2932628. DOI: 10.1001/jama.300.2.197. View

16.

Ridker P . C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol. 2007; 49(21):2129-38. DOI: 10.1016/j.jacc.2007.02.052. View

17.

Matsushita K, van der Velde M, Astor B, Woodward M, Levey A, de Jong P . Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010; 375(9731):2073-81. PMC: 3993088. DOI: 10.1016/S0140-6736(10)60674-5. View

18.

Ponholzer A, Temml C, Obermayr R, Wehrberger C, Madersbacher S . Is erectile dysfunction an indicator for increased risk of coronary heart disease and stroke?. Eur Urol. 2005; 48(3):512-8. DOI: 10.1016/j.eururo.2005.05.014. View

19.

DeBusk R, Drory Y, Goldstein I, Jackson G, Kaul S, Kimmel S . Management of sexual dysfunction in patients with cardiovascular disease: recommendations of The Princeton Consensus Panel. Am J Cardiol. 2000; 86(2):175-81. DOI: 10.1016/s0002-9149(00)00896-1. View

20.

Llisterri J, Lozano Vidal J, Aznar Vicente J, Argaya Roca M, Pol Bravo C, Sanchez Zamorano M . Sexual dysfunction in hypertensive patients treated with losartan. Am J Med Sci. 2001; 321(5):336-41. DOI: 10.1097/00000441-200105000-00006. View