Heart Failure and Erectile Dysfunction: a Review of the Current Evidence and Clinical Implications.

IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Current Heart Failure Reports Pub Date : 2023-12-01 Epub Date: 2023-11-14 DOI:10.1007/s11897-023-00632-y
Maria Cristina Carella, Cinzia Forleo, Alessandro Stanca, Eugenio Carulli, Paolo Basile, Umberto Carbonara, Fabio Amati, Saima Mushtaq, Andrea Baggiano, Gianluca Pontone, Marco Matteo Ciccone, Andrea Igoren Guaricci
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Abstract

Purpose of review: Heart failure (HF) and erectile dysfunction (ED) are two common conditions that affect millions of men worldwide and impair their quality of life. ED is a frequent complication of HF, as well as a possible predictor of cardiovascular events and mortality. ED deserves more attention from clinicians and researchers.

Recent findings: The pathophysiology of ED in HF involves multiple factors, such as endothelial dysfunction, reduced cardiac output, neurohormonal activation, autonomic imbalance, oxidative stress, inflammation, and drug side effects. The diagnosis of ED in HF patients should be based on validated questionnaires or objective tests, as part of the routine cardiovascular risk assessment. The therapeutic management of ED in HF patients should be individualized and multidisciplinary, considering the patient's preferences, expectations, comorbidities, and potential drug interactions. The first-line pharmacological treatment for ED in HF patients with mild to moderate symptoms (NYHA class I-II) is phosphodiesterase type 5 inhibitors (PDE5Is), which improve both sexual function and cardiopulmonary parameters. PDE5Is are contraindicated in patients who use nitrates or nitric oxide donors for angina relief, and these patients should be advised to avoid sexual activity or to use alternative treatments for ED. Non-pharmacological treatments for ED, such as psychotherapy or couples therapy, should also be considered if there are significant psychosocial factors affecting the patient's sexual function or relationship. This review aims to summarize the most recent evidence regarding the prevalence of ED, the pathophysiology of this condition with an exhaustive analysis of factors involved in ED development in HF patients, a thorough discussion on diagnosis and management of ED in HF patients, providing practical recommendations for clinicians.

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心力衰竭和勃起功能障碍:当前证据和临床意义的回顾。
综述目的:心力衰竭(HF)和勃起功能障碍(ED)是影响全球数百万男性并影响其生活质量的两种常见疾病。ED是心衰的常见并发症,也是心血管事件和死亡率的可能预测因子。ED值得临床医生和研究人员更多的关注。近期发现:HF患者ED的病理生理涉及多种因素,如内皮功能障碍、心输出量减少、神经激素激活、自主神经失衡、氧化应激、炎症和药物副作用。心衰患者ED的诊断应基于有效的问卷或客观测试,作为常规心血管风险评估的一部分。心衰患者ED的治疗管理应个性化和多学科,考虑患者的偏好、期望、合并症和潜在的药物相互作用。轻中度症状(NYHA I-II类)的HF患者ED的一线药物治疗是磷酸二酯酶5型抑制剂(PDE5Is),可改善性功能和心肺参数。使用硝酸盐或一氧化氮供体缓解心绞痛的患者禁用PDE5Is,应建议这些患者避免性活动或使用其他ED治疗方法。如果存在影响患者性功能或两性关系的重大社会心理因素,也应考虑使用非药物治疗,如心理治疗或夫妻治疗。本文旨在总结有关ED患病率的最新证据,该疾病的病理生理学,详尽分析HF患者ED发展的相关因素,深入讨论HF患者ED的诊断和治疗,为临床医生提供实用建议。
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来源期刊
Current Heart Failure Reports
Current Heart Failure Reports Medicine-Emergency Medicine
CiteScore
5.30
自引率
0.00%
发文量
44
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of heart failure. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as investigative, pharmacologic, and nonpharmacologic therapies, pathophysiology, and prevention. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
期刊最新文献
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