In 1999, 1 year after the approval of the first oral phosphodiesterase type 5 (PDE5) inhibitor for the treatment of erectile dysfunction(ED), the first Princeton Consensus Conference was held to address the clinical management of men with ED who also had cardiovascular disease. These issues were readdressed in the second and third conferences. In the 13 years since the last Princeton Consensus Conference, the experience with PDE5 inhibitors is more robust, and recent new data have emerged regarding not only...
Independent Risk Marker: Erectile dysfunction (ED) should be considered an independent risk marker for coronary artery disease (CAD). It predates significant cardiac events, including myocardial infarctions and sudden cardiac deaths, often by several years. Thus, it can serve as an early indicator for potential cardiovascular issues.
Inclusion in Risk Calculators: The P4 panel advocates for the inclusion of ED as a risk-enhancing factor in cardiovascular risk assessment tools. Currently, only the QRISK calculator incorporates...
* The P4 panel recommendations confirm that ED is a strong, independent predictor of cardiac events, even when traditional risk factors such as cholesterol, diabetes and blood pressure are controlled for. In short, ED is the body's "check engine light" for heart disease.
* Phosphodiesterase-5 (PDE5) inhibitors — such as sildenafil and tadalafil — remain first line therapy for ED. The P4 recommendations, however, suggest that these medications may offer more than symptom relief. Multiple large studies show that men taking PDE5 inhibitors have lower rates of heart...
I have been stressing this numerous times over the years.
ED is multifactorial and vascular issues are the most common cause.
Stop getting caught up on T, DHT, estradiol let alone the myth that one needs high FT/DHT!
T plays a small role.
What about testosterone?
* testosterone is a hormone that works all over the body and it has a small role with erections but it has a big role with libido or sex drive so it is important but the key essential components is blood flow and nervous conduction
* You need to lose about 75% of the lumen of the coronary artery before you get your first cardiac symptom but if you lose even a small amount of the very small penile artery you get sexual problems
Dr. Mike Kirby
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