Erectile Dysfunction Predicts Cardiovascular Events in High-Risk Patients Receiving Telmisartan, Ramipril, or Both The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials

Department of Cardiology, University of the Saarland, Saarbrücken, Germany.
Circulation (Impact Factor: 14.43). 03/2010; 121(12):1439-46. DOI: 10.1161/CIRCULATIONAHA.109.864199
Source: PubMed


Although erectile dysfunction (ED) is associated with cardiovascular risk factors and atherosclerosis, it is not known whether the presence of ED is predictive of future events in individuals with cardiovascular disease. We evaluated whether ED is predictive of mortality and cardiovascular outcomes, and because inhibition of the renin-angiotensin system in high-risk patients reduces cardiovascular events, we also tested the effects on ED of randomized treatments with telmisartan, ramipril, and the combination of the 2 drugs (ONTARGET), as well as with telmisartan or placebo in patients who were intolerant of angiotensin-converting enzyme inhibitors (TRANSCEND).
In a prespecified substudy, 1549 patients underwent double-blind randomization, with 400 participants assigned to receive ramipril, 395 telmisartan, and 381 the combination thereof (ONTARGET), as well as 171 participants assigned to receive telmisartan and 202 placebo (TRANSCEND). ED was evaluated at baseline, at 2-year follow-up, and at the penultimate visit before closeout. ED was predictive of all-cause death (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.21 to 2.81, P=0.005) and the composite primary outcome (HR 1.42, 95% CI 1.04 to 1.94, P=0.029), which consisted of cardiovascular death (HR 1.93, 95% CI 1.13 to 3.29, P=0.016), myocardial infarction (HR 2.02, 95% CI 1.13 to 3.58, P=0.017), hospitalization for heart failure (HR 1.2, 95% CI 0.64 to 2.26, P=0.563), and stroke (HR 1.1, 95% CI 0.64 to 1.9, P=0.742). The study medications did not influence the course or development of ED.
ED is a potent predictor of all-cause death and the composite of cardiovascular death, myocardial infarction, stroke, and heart failure in men with cardiovascular disease. Trial treatment did not significantly improve or worsen ED.
URL: Unique identifier: NCT 00153101.

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    • "A consensus exists to consider ED an independent predictor of CVD [31] [32] [33] [34] [35] [36], including CAD [37], peripheral artery disease [38], and stroke [39]. The early symptom of erectile difficulty often occurs before the development of structural, occlusive arterial disease and may therefore be one of the first signs of systemic vascular disease [14]. "
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    ABSTRACT: Background: Evidence is accumulating in favour of a link between erectile dysfunction (ED) and coronary artery diseases. We investigated the presence of cardiac injury in patients who have had arteriogenic and nonarteriogenic ED using the hs-Tn levels. Methods: The diagnosis of ED was based on the International Index of Erectile Function 5-questionnaire (IIF-5) and patients were classified as arteriogenic (A-ED, n = 40), nonarteriogenic (NA-ED, n = 48), and borderline (BL-ED, n = 32) patients in relation to the results of echo-color-Doppler examination of cavernous arteries. The level of hs-TnT and hs-TnI was measured in 120 men with a history of ED of less than one year with no clinical evidence of cardiac ischemic disease. Results: The levels of both hs-TnT and hs-TnI were within the reference range and there was no significant (P > 0.05) difference between patients of the three groups. The hs-CRP values were higher in A-ED men compared with NA-ED (P = 0.048) but not compared with BL-ED (P = 0.136) and negatively correlated with IIF-5 (r = -0.480; P = 0.031). Conclusions: In ED patients of the three groups the measurement of hs-Tn allows us to exclude the presence of cardiac involvement at least when the history of ED is less than one year and the men are without atherosclerotic risk factors.
    Disease markers 04/2015; 2015. DOI:10.1155/2015/548951 · 1.56 Impact Factor
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    • "Epidemiological studies estimated the prevalence of moderate to severe ED in the age range of 5–20% of men [5]. It is now well accepted that ED may be associated with cardiovascular risk factors as well as cardiovascular underlying diseases [6]. In other words, risk factors for ED and cardiovascular disorders are defined similarly [7]. "

    International journal of cardiology 05/2014; 175(2). DOI:10.1016/j.ijcard.2014.04.251 · 4.04 Impact Factor
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    • "The beneficial effects on sexual function were confirmed in a study among 2202 hypertensive patients, reporting an increase of sexual intercourse per week when treated with valsartan. A recent double-blind randomised study among 1549 patients in which 400 participants received ramipril, 395 telmisartan and 381 a combination of the two, no benefits of ARBs on erectile dysfunction were proven [55]. It was noted, however, that ARBs were added on top of the previous multidrug regime in high-risk patients and thus conclusions regarding the effects of ARB monotherapy cannot be drawn [56]. "
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    ABSTRACT: Several antihypertensive drugs, such as diuretics and β-blockers, can negatively affect sexual function, leading to diminished quality of life and often to noncompliance with the therapy. Other drug classes, however, such as angiotensin II receptor blockers (ARBs) are able to improve patients' sexual function. Sufficient knowledge about the effects of these widely used antihypertensive drugs will make it possible for cardiologists and general practitioners to spare and even improve patients' sexual health by switching to different classes of cardiac medication. Nevertheless, previous data (part I) indicate that most cardiologists lack knowledge about the effects cardiovascular agents can have on sexual function and will thus not be able to provide the necessary holistic patient care with regard to prescribing these drugs. To be able to improve healthcare on this point, we aimed to provide a practical overview, for use by cardiologists as well as other healthcare professionals, dealing with sexual dysfunction in their clinical practices. Therefore, a systematic review of the literature was performed. The eight most widely used classes of antihypertensive drugs have been categorised in a clear table, marking whether they have a positive, negative or no effect on sexual function.
    Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 10/2013; 22(1). DOI:10.1007/s12471-013-0482-z · 1.84 Impact Factor
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