Cardiovascular risk factors and erectile dysfunction

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