Erectile dysfunction may be early symptom of heart attack

Erectile dysfunction may be the early warning predictor symptom of heart attack. However, the link between erectile dysfunction and the risk of heart disease is being ignored by doctors, writes Dr Geoffrey Hackett from the Good Hope Hospital in Birmingham.

Over many years Hackett reports regularly seeing patients referred with erectile dysfunction after a heart attack, only to hear that they had developed erectile dysfunction two to three years before - a warning sign ignored by their general practitioners.

It is well known that erectile dysfunction (a symptom of vascular disease in the smaller arteries) doubles the risk of heart disease, a risk equivalent to being a moderate smoker or having an immediate family history of heart disease. Erectile dysfunction in type 2 diabetes has been shown to be a better predictor of the risk of heart disease than high blood pressure or high cholesterol.

But despite this considerable evidence erectile dysfunction is still treated as a recreational or "lifestyle issue" rather than a predictor of a serious health problem, says Hackett.

The UK government has pledged to reduce the death rate from coronary heart disease and stroke and related diseases in people under 75 by at least 40% by 2010, yet there is no screening for erectile dysfunction in patients with diabetes or heart disease, he says.

"Continuing to ignore these issues on the basis that cardiologists feel uncomfortable mentioning the word 'erection' to their patients or that they may have to deal with the management of a positive response, is no longer acceptable and possibly, based on current evidence, clinically negligent", he concludes.

FDA Approves Cialis For Treatment Of Erectile Dysfunction

FDA has approved Eli Lilly and Company’s Cialis (tadalafil) for once daily use (2.5 mg and 5 mg), an oral medication taken once per day to treat erectile dysfunction (ED). When Cialis for once daily use is taken daily, men can attempt sexual activity at anytime between doses.

Currently available in parts of Europe, this low-dose daily treatment option of Cialis may be most appropriate for men with ED who anticipate more frequent sexual activity (e.g. twice weekly). For other men, Cialis taken as needed – the previously approved dosing regimen – may be most appropriate.

In clinical trials, when taken without restrictions on the timing of sexual activity, Cialis for once daily use improved erectile function over the course of therapy.

"ED can be a chronic condition like diabetes or high blood pressure," said Ridwan Shabsigh, M.D., Director of the Division of Urology at Maimonides Medical Center in New York. "As a urologist, I know couples like to have choices and will appreciate the availability of Cialis for once daily use."

Cialis for use as needed transformed the U.S. ED market when it was approved in 2003 as the first and only PDE5 inhibitor clinically proven to provide sustained efficacy for up to 36 hours. Cialis for once daily use provides a new option for men who may be looking for a dosing option that can be taken without regard to timing of sexual activity. In consultation with their physician, patients now have the freedom to choose the dosing regimen that is appropriate for them.

"We strive to provide patients with solutions that fit their needs and Cialis for once daily use delivers on this promise," said Shawn Heffern, Cialis U.S. Director of Brand Marketing at Lilly. "Now, patients have two options – some may prefer the up to 36 hours of efficacy provided by Cialis for use as needed while others may want the unique benefit provided by this daily dosing option."

Additionally, Lilly’s wholesale pricing for Cialis for once daily use will be comparable to Cialis for use as needed such that patients who currently use two or more pills per week of Cialis for use as needed should not experience higher treatment costs with Cialis for once daily use.

The FDA’s approval of Cialis for once daily use was based upon the evaluation of the comprehensive data package for the daily dosing option. The data include results from three phase III randomized, double-blind, placebo- controlled studies. Men with ED who participated in these clinical studies and who took tadalafil 2.5 mg and 5 mg once daily without regard to their timing of sexual activity experienced improved erectile function compared with those taking placebo. Cialis 5 mg, 10 mg and 20 mg have been approved in the United States for as-needed treatment of ED since November 2003.

The most commonly reported adverse events were headache, indigestion, back pain, muscle aches, nasal congestion, flushing and pain in limb. Most adverse events reported with tadalafil were transient and generally mild or moderate.

Don’t Mix Erectile Dysfunction Pills With These Medications

Group warns impotence drug users by listing 56 medications that may cause dangerous interactions or alter the effectiveness of erectile dysfunction drugs.

People who take three well-known erectile dysfunction medications should be extremely careful if they take any of 56 other drugs, including many commonly prescribed anti-angina and certain blood pressure medications, grapefruit juice and St. John’s Wort, Public Citizen writes in a new January article posted on its WorstPills.org Web site.

The three erectile dysfunction drugs are Viagra (chemical name sildenafil), Cialis (tadalafil) and Levitra (vardenafil). The 56 drugs fall into three categories: 1) those that can cause a life-threatening drop in blood pressure when taken with erectile dysfunction drugs; 2) those that prevent the body from eliminating erectile dysfunction drugs, thereby leading to an overdose; and 3) those that speed up the metabolism of the erectile dysfunction drugs, thereby reducing their effectiveness. Grapefruit juice also is listed in the second category because it acts like a drug in this circumstance.

“Those who take erectile dysfunction drugs are generally older men, who are more likely to be taking other medications as well,” said Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen. “It is critical that they be aware of the potential for dangerous interactions.”

Erectile dysfunction drugs cause blood vessels to dilate, an effect that is magnified when taken with blood pressure medications, which also dilate blood vessels. So men who take blood pressure medications such as Flomax and Cardura should avoid erectile dysfunction drugs, Wolfe said. The combination can cause a dangerous drop in blood pressure that could lead to a heart attack or stroke.

Other drugs, such as erythromycin and nefazodone, inhibit an enzyme that metabolizes erectile dysfunction medications, thereby causing a build-up of the erectile dysfunction drugs to higher levels. Still other medications, like nafcillin, phenobarbital and 13 other drugs, increase the activity of the enzyme, rendering the erectile dysfunction drugs less effective. St. John’s Wort, an herbal supplement, also falls into this third category because it has a negative, drug-like effect when used with erectile dysfunction drugs.

The complete list of 56 drugs is at Public Citizen’s WorstPills.org, along with an explanatory article from Worst Pills, Best Pills, a monthly newsletter available in print and electronic formats through the subscription site WorstPills.org. The article about harmful interactions with erectile dysfunction drugs will be available free for the next seven days. The site has other searchable information about the uses, risks and adverse effects associated with prescription medications.

WorstPills.org is an unbiased analysis of information from a variety of sources – including well-regarded medical journals and unpublished data obtained from the Food and Drug Administration – that allows Public Citizen to warn the public about potentially dangerous drugs long before they are banned or adequately regulated by the federal government. For example, Public Citizen warned consumers about the dangers of Vioxx, ephedra, Baycol and Propulsid years before they were pulled from the market.

Hong Kong Urges Not To Consume Sexual Dysfunction Managing Products

Hong Kong Department Of Health appealed to members of the public not to buy or use a product named “Chong Cao Ju Wang” as it was found to contain an undeclared drug which is known to link with serious side effects.

A DH spokesman said a 69-year-old man was admitted to United Christian Hospital on July 23 after he was found unconscious at home. His blood glucose level was very low on admission.

Investigation revealed that he had a history of taking the above mentioned product purchased at a drug shop in Shenzhen. The urine of the patient was found to have contained glibenclamide (a diabetic drug) and sildenafil (a drug used for treating male sexual dysfunction).

Today, laboratory tests on one remaining capsule of the product provided by the patient showed the presence of sildenafil.

The spokesman said glibenclamide could cause nausea and gastro-intestinal upset. Improper use may cause a significant fall in blood sugar level with serious health consequence and even death.

The side effects of sildenafil include low blood pressure, headache, vomiting, dizziness, and transient vision disturbances. It may interact with nitrates found in some prescription drugs (such as nitroglycerin for treatment of angina) and may lower blood pressure of patients to dangerous levels. Improper use of sildenafil may pose serious health risks, especially for patients with heart problems.

Under the Pharmacy and Poisons Ordinance of Hong Kong, products containing either sildenafil or glibenclamide must be registered before sale and can only be sold on a doctor’s prescription and under supervision of a pharmacist.

Members of the public who have bought the product are advised not to take it. Moreover, they are urged to seek advice from their doctors if feeling unwell after consuming the product.

They should destroy and dispose of the products or submit them to the Department’s Pharmaceutical Service at 3/F, Public Health Laboratory Centre, 382 Nam Cheong Street, Kowloon, during office hours.

“People who have problems of sexual dysfunction should consult medical professionals for appropriate advice or medication,” the spokesman said.

ErecAid Supplemental: Effective Erectile Dysfunction Treatment

Plethora Solutions Holdings PLC ("Plethora", AIM: PLE), the specialist developer of products for the treatment and management of urological disorders, announces results of a study confirming the role its product, ErecAid, as a supplemental first line treatment for erectile dysfunction (ED). ErecAid is marketed through Plethora's US subsidiary, Timm Medical Technologies, Inc. ("Timm Medical", Minneapolis, MN).

The phosphodiesterase five inhibitors (PDE5i) such as Viagra and Cialis have become a major resource in the management of ED. Unfortunately, 30-50% of men report inadequate results with these oral medications. When patients fail to respond to the oral medications, physicians are often forced to consider more invasive and more complicated second line agents such as penile injections or urethral suppositories.

New data from a multi-center clinical trial led by investigators at Johns Hopkins School of Medicine demonstrate that use of the ErecAid vacuum erection device to augment PDE5i therapy can greatly improve patient satisfaction. Results of the study were presented at a recent North Central Sectional meeting of the American Urological Association.

Investigators at four separate study sites evaluated 69 men aged 36 to 82 with ED of diverse etiology who had responded inadequately to PDE5i therapy. Study subjects were allowed to continue use of PDE5i's but were instructed to use the ErecAid device as an adjunct to their current oral medication. Study subjects were assessed using three validated measurements of erectile function and sexual satisfaction: the International Index of Erectile Function (IIEF-5), the Sexual Encounter Profile (SEP-2 and SEP-3) and the Global Patient Assessment Scale (GAPS).

After 4 weeks of supplemental treatment with ErecAid, the IIEF-5 score improved substantially from a baseline of 9.0 to 17.6 (p<0.001). Moreover, of the 34 subjects unable to achieve an erection satisfactory for intercourse at baseline (SEP-2 response of "no"), 27 subjects (79%) reported erections satisfactory for intercourse following the addition of ErecAid (p<0.001). Finally, of 42 subjects reporting no or slight response to PDE5i at baseline (GAPS responses of "not at all" or "slightly"), 31 (74%) reported moderate or great improvement (GAPS responses of "moderately" or "greatly") at the end of the 4 week study (p<0.001).

According to Dr. Arthur Burnett, Professor of Urology at Johns Hopkins School of Medicine and the lead investigator of this trial, "This study confirms an earlier trial that many patients can achieve excellent results using ErecAid as an addition to oral PDE5i therapy. Based upon these results, I would encourage physicians treating ED to consider the importance of this approach in their treatment protocols and to discuss this option with their patients."

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