Advances in pharmacotherapy for erectile dysfunction and associated cardiac impact

ABSTRACT

Introduction: Cardiovascular disease (CVD) and erectile dysfunction (ED) are two disease processes that affect millions of men. CVD and ED are increasingly recognized as sharing a common pathophysiologic origin. As the nature of this relationship continues to be elucidated, there is growing interest in developing a therapy to effectively target both processes. While researchers have largely focused on phosphodiesterase-5 inhibitors (PDE5Is), the established first-line therapy for ED, newer ED drugs, designed based on better understanding of the physiology of erection, may also show promise.

Areas covered: This paper will review the relationship between ED and CVD, as well as the currently available and investigational pharmacologic treatments for ED. The particular focus will be on the role that these therapies play in managing CVD.

Expert opinion: PDE5Is, along with the newer ED therapies, are promising candidates for managing ED and concurrently providing cardioprotection. Despite some in vitro success with PDE5Is, maxi-K channel activators, and guanylyl cyclase (GC) stimulators, in vivo studies have either been lacking, or shown conflicting results. More well designed clinical studies are needed in order to characterize an ED pharmacotherapy that offers proven cardioprotection.

KEYWORDS:

• Cardiovascular disease
• coronary artery disease
• erectile dysfunction
• GC stimulators
• major adverse cardiovascular events
• maxi-k channel activators
• pharmacotherapy
• phosphodiesterase type 5 inhibitors

Article highlights

• ED and CVD share common pathophysiologic pathways and exist as a continuum of the same systemic disease process; ED can be considered a predictor of CVD.

• Given the well-established safety profile of PDE5Is, many researchers are more interested in exploring the possible cardioprotective nature of this common ED therapy.

• Clinical results regarding cardioprotection from PDE5Is have been contradictory; we do not currently understand the mechanism of cardioprotection offered by PDE5Is.

• Better understanding of the physiology of erection has led to the development of novel ED therapies, such as sGC stimulators and maxi-K channel activators. These therapies may change how physicians manage ED in the future.

• More investigation is needed on novel ED therapies in order to establish their utility in managing ED and/or CVD.

This box summarizes key points contained in the article.

Declaration of interest

W G Hellstrom is a consultant for Abbvie, Allergan, Boston Scientific, Astellas, Coloplast, Endo, Lipocine Inc., Pfizer and Repros Therapeutics; an advisor for Abbvie, Allergan, Boston Scientific, Astellas, Coloplast, Endo, Lipocine Inc., Pfizer and Repros Therapeutics; an investigator for Coloplast, Endo and New England Research Institutes, Inc.; a lecturer for Endo and Menarini; and a Board member, Officer and Trustee for the NIH and Theralogix. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded