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CC BY-NC-ND 4.0 · Revista Urología Colombiana / Colombian Urology Journal 2022; 31(03): e121-e129
DOI: 10.1055/s-0042-1746202
Artículo de Revisión | Review Article

Enfermedad cardiovascular aterosclerótica y sexualidad

Atherosclerotic Cardiovascular Disease and Sexuality
Sebastián Galvis-Acevedo 
1   Departamento de Medicina Familiar, Escuela de Medicina, Universidad del Valle, Cali, Colombia
,
Daniela Rivas-Escobar
1   Departamento de Medicina Familiar, Escuela de Medicina, Universidad del Valle, Cali, Colombia
,
Liliana Arias-Castillo 
1   Departamento de Medicina Familiar, Escuela de Medicina, Universidad del Valle, Cali, Colombia
,
Herney Andrés García-Perdomo 
2   Departamento de Cirugía/Urología, Escuela de Medicina, Universidad del Valle, Cali, Colombia
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Resumen

La enfermedad cardiovascular aterosclerótica es la primera causa de muerte en todo el mundo, y la principal causa de años de vida perdidos por discapacidad (AVADs) en los adultos. Sus factores de riesgo son muy prevalentes en la población, y su ocurrencia se ha asociado con disfunción sexual tanto en hombres como en mujeres, debido a que comparten un mecanismo fisiopatológico similar en el caso de la disfunción eréctil en los hombres y potencialmente en la disfunción sexual femenina. Además, los trastornos mentales asociados (principalmente ansiedad y depresión) y los efectos adversos de los medicamentos antihipertensivos y antidepresivos también contribuyen a las disfunciones sexuales. Por otro lado, los inhibidores de la fosfodiesterasa 5 (iFDE5s) han demostrado seguridad y beneficios cardiovasculares en los hombres, y en las mujeres hay evidencia creciente de su utilidad en las disfunciones sexuales. En esta revisión, se presentan las implicaciones de la enfermedad cardiovascular aterosclerótica y su tratamiento en la vida sexual de hombres y mujeres, los efectos cardiovasculares de los tratamientos de las disfunciones sexuales, y la consejería a los pacientes.

Abstract

Atherosclerotic cardiovascular disease is the leading cause of death worldwide and the leading cause of disability-adjusted life years (DALYs). Its risk factors are very prevalent in the population, and its occurrence has been associated with sexual dysfunction in both men and women, because they share a similar pathophysiological mechanism in the case of erectile dysfunction in men and potentially in female sexual dysfunction. Furthermore, associated mental disorders (mainly anxiety and depression) and the adverse effects of antihypertensive drugs and antidepressants also contribute to sexual dysfunction. On the other hand, phosphodiesterase 5 inhibitors (PDE5is) have shown safety and cardiovascular benefits in men, and in women there is growing evidence of their usefulness in female sexual dysfunctions. The present review describes the implications of atherosclerotic cardiovascular disease and its treatment on the sexual lives of men and women, the cardiovascular effects of the treatments for sexual dysfunctions, and patient counseling.

Palabras Clave

enfermedad cardiovascular - sexualidad - antidepresivos - inhibidores de la fosfodiesterasa 5

Keywords

cardiovascular disease - sexuality - antidepressants - phosphodiesterase 5 inhibitors

Recomendaciones

En conformidad con la evidencia disponible consultada y de acuerdo con las últimas recomendaciones de la American Heart Association en esta materia, en pacientes con ECVA que acuden a consulta externa por disfunción sexual, se sugiere: a) evaluar el riesgo de ECVs para la consejería en sexualidad ([figura 2]); b) la modificación de estilos de vida saludables para el manejo de los FRCVs y realizar búsqueda activa de ECVA en pacientes masculinos con DE; c) no proscribir la actividad sexual en pacientes con IAM después de la primera semana de la revascularización coronaria completa; en aquellos con revascularización incompleta o que persisten sintomáticos, se recomienda la realización de prueba de esfuerzo para tomar la decisión; y d) consejería en pacientes que han sufrido un ECV para reanudar seguramente la actividad sexual, disminuir el estrés asociado, y aumentar la satisfacción asociada a la actividad sexual.


Financiación

Los autores declaran que el presente estudio no recibió apoyo económico.




Publication History

Received: 30 December 2021

Accepted: 07 March 2022

Article published online:
28 September 2022

© 2022. Sociedad Colombiana de Urología. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referencias

  • 1 Benjamin EJ, Virani SS, Callaway CW. et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137 (12) e67-e492
    CrossrefPubMedGoogle Scholar
  • 2 Vos T, Lim SS, Abbafati C. et al; GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396 (10258): 1204-1222
    CrossrefPubMedGoogle Scholar
  • 3 Visseren FLJ, Mach F, Smulders YM. et al; ESC National Cardiac Societies, ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42 (34) 3227-3337
    CrossrefPubMedGoogle Scholar
  • 4 Man JJ, Beckman JA, Jaffe IZ. Sex as a Biological Variable in Atherosclerosis. Circ Res 2020; 126 (09) 1297-1319
    CrossrefPubMedGoogle Scholar
  • 5 Murphy B, Le Grande M, Alvarenga M, Worcester M, Jackson A. Anxiety and depression after a cardiac event: Prevalence and predictors. Front Psychol 2020; 10 (3010): 3010
    CrossrefPubMedGoogle Scholar
  • 6 AlBreiki M, AlMaqbali M, AlRisi K, AlSinawi H, Al Balushi M, Al Zakwani W. Prevalence of antidepressant-induced sexual dysfunction among psychiatric outpatients attending a tertiary care hospital. Neurosciences (Riyadh) 2020; 25 (01) 55-60
    CrossrefPubMedGoogle Scholar
  • 7 Grace SL, Medina-Inojosa JR, Thomas RJ. et al. Antidepressant use by class: Association with major adverse cardiac events in patients with coronary artery disease. Psychother Psychosom 2018; 87 (02) 85-94
    CrossrefPubMedGoogle Scholar
  • 8 Jang HY, Kim JH, Song Y-K. et al. Antidepressant Use and the Risk of Major Adverse Cardiovascular Events in Patients Without Known Cardiovascular Disease: A Retrospective Cohort Study. Front Pharmacol 2020; 11: 594474
    CrossrefPubMedGoogle Scholar
  • 9 Terentes-Printzios D, Ioakeimidis N, Rokkas K, Vlachopoulos C. Interactions between erectile dysfunction, cardiovascular disease and cardiovascular drugs. Nat Rev Cardiol 2021; •••: 1-16
    PubMedGoogle Scholar
  • 10 Montorsi P, Montorsi F, Schulman CC. Is erectile dysfunction the “tip of the iceberg” of a systemic vascular disorder? Vol. 44. European urology; Switzerland: 2003: 352-4
    Google Scholar
  • 11 Montorsi F, Briganti A, Salonia A. et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol 2003; 44 (03) 360-364 , discussion 364–365
    CrossrefPubMedGoogle Scholar
  • 12 Zhao B, Zhang W. Does erectile dysfunction independently predict cardiovascular events? It's time to act on the evidence. Eur J Prev Cardiol 2018; 25 (12) 1307-1311
    CrossrefPubMedGoogle Scholar
  • 13 Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes 2013; 6 (01) 99-109
    CrossrefPubMedGoogle Scholar
  • 14 Vlachopoulos C, Ioakeimidis N, Terentes-Printzios D. et al. Plasma total testosterone and incident cardiovascular events in hypertensive patients. Am J Hypertens 2013; 26 (03) 373-381
    CrossrefPubMedGoogle Scholar
  • 15 Gagliano-Jucá T, Basaria S. Testosterone replacement therapy and cardiovascular risk. Nat Rev Cardiol 2019; 16 (09) 555-574
    CrossrefPubMedGoogle Scholar
  • 16 Budoff MJ, Ellenberg SS, Lewis CE. et al. Testosterone Treatment and Coronary Artery Plaque Volume in Older Men With Low Testosterone. JAMA 2017; 317 (07) 708-716
    CrossrefPubMedGoogle Scholar
  • 17 Basaria S, Coviello AD, Travison TG. et al. Adverse events associated with testosterone administration. N Engl J Med 2010; 363 (02) 109-122
    CrossrefPubMedGoogle Scholar
  • 18 Araujo AB, Hall SA, Ganz P. et al. Does erectile dysfunction contribute to cardiovascular disease risk prediction beyond the Framingham risk score?. J Am Coll Cardiol 2010; 55 (04) 350-356
    CrossrefPubMedGoogle Scholar
  • 19 Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality-Part II. Understanding (and Overcoming) Gender Differences: The Key Role of an Adequate Methodological Approach. Sex Med Rev 2018; 6 (04) 525-534
    CrossrefPubMedGoogle Scholar
  • 20 Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality-Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes. Sex Med Rev 2018; 6 (04) 508-524
    CrossrefPubMedGoogle Scholar
  • 21 Calmasini FB, Klee N, Webb RC, Priviero F. Impact of Immune System Activation and Vascular Impairment on Male and Female Sexual Dysfunction. Sex Med Rev 2019; 7 (04) 604-613
    CrossrefPubMedGoogle Scholar
  • 22 Chen X, Zhang Q, Tan X. Cardiovascular effects of sexual activity. Indian J Med Res 2009; 130 (06) 681-688
    PubMedGoogle Scholar
  • 23 Levine GN, Steinke EE, Bakaeen FG. et al; American Heart Association Council on Clinical Cardiology, Council on Cardiovascular Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Quality of Care and Outcomes Research. Sexual activity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2012; 125 (08) 1058-1072
    CrossrefPubMedGoogle Scholar
  • 24 Garner KK, Pomeroy W, Arnold JJ. Exercise stress testing: indications and common questions. Am Fam Physician 2017; 96 (05) 293-299
    PubMedGoogle Scholar
  • 25 Knuuti J, Wijns W, Saraste A. et al; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41 (03) 407-477
    CrossrefPubMedGoogle Scholar
  • 26 Muller JE, Mittleman MA, Maclure M, Sherwood JB, Tofler GH. Determinants of Myocardial Infarction Onset Study Investigators. Triggering myocardial infarction by sexual activity. Low absolute risk and prevention by regular physical exertion. JAMA 1996; 275 (18) 1405-1409
    CrossrefPubMedGoogle Scholar
  • 27 Dahabreh IJ, Paulus JK. Association of episodic physical and sexual activity with triggering of acute cardiac events: systematic review and meta-analysis. JAMA 2011; 305 (12) 1225-1233
    CrossrefPubMedGoogle Scholar
  • 28 Möller J, Ahlbom A, Hulting J. et al. Sexual activity as a trigger of myocardial infarction. A case-crossover analysis in the Stockholm Heart Epidemiology Programme (SHEEP). Heart 2001; 86 (04) 387-390
    CrossrefPubMedGoogle Scholar
  • 29 Haykowsky M, Scott J, Esch B. et al. A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling. Trials 2011; 12 (01) 92
    CrossrefPubMedGoogle Scholar
  • 30 Mornar Jelavić M, Krstačić G, Perenčević A, Pintarić H. Sexual activity in patients with cardiac diseases. Acta Clin Croat 2018; 57 (01) 141-148
    CrossrefPubMedGoogle Scholar
  • 31 Cordero A, Bertomeu-Martínez V, Mazón P. et al. Erectile dysfunction in high-risk hypertensive patients treated with beta-blockade agents. Cardiovasc Ther 2010; 28 (01) 15-22
    CrossrefPubMedGoogle Scholar
  • 32 Corona G, Isidori AM, Aversa A. et al. Male and female sexual dysfunction in diabetic subjects: Focus on new antihyperglycemic drugs. Rev Endocr Metab Disord 2020; 21 (01) 57-65
    CrossrefPubMedGoogle Scholar
  • 33 Parthasarathy HK, Ménard J, White WB. et al. A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism. J Hypertens 2011; 29 (05) 980-990
    CrossrefPubMedGoogle Scholar
  • 34 Huang SA, Lie JD. Phosphodiesterase-5 (PDE5) inhibitors in the management of erectile dysfunction. P&T 2013; 38 (07) 407-419
    PubMedGoogle Scholar
  • 35 Kloner RA, Goldstein I, Kirby MG, Parker JD, Sadovsky R. Cardiovascular Safety of Phosphodiesterase Type 5 Inhibitors After Nearly 2 Decades on the Market. Sex Med Rev 2018; 6 (04) 583-594
    CrossrefPubMedGoogle Scholar
  • 36 Mittleman MA, Maclure M, Glasser DB. Evaluation of acute risk for myocardial infarction in men treated with sildenafil citrate. Am J Cardiol 2005; 96 (03) 443-446
    CrossrefPubMedGoogle Scholar
  • 37 Hutchings DC, Anderson SG, Caldwell JL, Trafford AW. Phosphodiesterase-5 inhibitors and the heart: compound cardioprotection?. Heart 2018; 104 (15) 1244-1250
    CrossrefPubMedGoogle Scholar
  • 38 Salloum FN, Abbate A, Das A. et al. Sildenafil (Viagra) attenuates ischemic cardiomyopathy and improves left ventricular function in mice. Am J Physiol Heart Circ Physiol 2008; 294 (03) H1398-H1406
    CrossrefPubMedGoogle Scholar
  • 39 Das S, Maulik N, Das DK, Kadowitz PJ, Bivalacqua TJ. Cardioprotection with sildenafil, a selective inhibitor of cyclic 3′,5′-monophosphate-specific phosphodiesterase 5. Drugs Exp Clin Res 2002; 28 (06) 213-219
    PubMedGoogle Scholar
  • 40 Lee DI, Vahebi S, Tocchetti CG. et al. PDE5A suppression of acute beta-adrenergic activation requires modulation of myocyte beta-3 signaling coupled to PKG-mediated troponin I phosphorylation. Basic Res Cardiol 2010; 105 (03) 337-347
    CrossrefPubMedGoogle Scholar
  • 41 Berman JR, Berman LA, Lin H, Flaherty E, Lahey N, Goldstein I, Cantey-Kiser J. Effect of sildenafil on subjective and physiologic parameters of the female sexual response in women with sexual arousal disorder. Journal of Sex & Marital Therapy 2001; 27 (05) 411-420
    CrossrefPubMedGoogle Scholar
  • 42 Denardo SJ, Wen X, Handberg EM. et al. Effect of phosphodiesterase type 5 inhibition on microvascular coronary dysfunction in women: a Women's Ischemia Syndrome Evaluation (WISE) ancillary study. Clin Cardiol 2011; 34 (08) 483-487
    CrossrefPubMedGoogle Scholar
  • 43 Nelson MD, Mehta PK, Wei J. et al. Phosphodiesterase type 5 inhibition may reduce diastolic function in women with ischemia but no obstructive coronary artery disease. J Med Case Reports 2017; 11 (01) 144
    CrossrefPubMedGoogle Scholar
  • 44 Sipski ML, Rosen RC, Alexander CJ, Hamer RM. Sildenafil effects on sexual and cardiovascular responses in women with spinal cord injury. Urology 2000; 55 (06) 812-815
    CrossrefPubMedGoogle Scholar
  • 45 Swann AC, Lijffijt M, Lane SD, Cox B, Steinberg JL, Moeller FG. Norepinephrine and impulsivity: effects of acute yohimbine. Psychopharmacology (Berl) 2013; 229 (01) 83-94
    CrossrefPubMedGoogle Scholar
  • 46 Banjarnahor S, Rodionov RN, König J, Maas R. Transport of L-Arginine Related Cardiovascular Risk Markers. J Clin Med 2020; 9 (12) 1-41
    CrossrefPubMedGoogle Scholar
  • 47 Corona G, Rastrelli G, Isidori AM. et al. Erectile dysfunction and cardiovascular risk: a review of current findings. Expert Rev Cardiovasc Ther 2020; 18 (03) 155-164
    CrossrefPubMedGoogle Scholar
  • 48 Mosack V, Steinke EE. Trends in sexual concerns after myocardial infarction. J Cardiovasc Nurs 2009; 24 (02) 162-170
    CrossrefPubMedGoogle Scholar
  • 49 Brotto L, Atallah S, Johnson-Agbakwu C. et al. Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction. J Sex Med 2016; 13 (04) 538-571
    CrossrefPubMedGoogle Scholar
  • 50 Byrne M, Doherty S, Fridlund BGA. et al. Sexual counselling for sexual problems in patients with cardiovascular disease. Cochrane Database Syst Rev 2016; 2 (02) CD010988
    PubMedGoogle Scholar
  • 51 Shah S, Patel AV, Patel K, Mehta PI. A prospective evaluation of a change in attitude towards sexuality in medical students after their three years in medical college. Arch Psychiatry Psychother 2020; 22 (02) 62-71
    CrossrefPubMedGoogle Scholar
  • 52 Komlenac N, Siller H, Hochleitner M. Medical Students Indicate the Need for Increased Sexuality Education at an Austrian Medical University. Sex Med 2019; 7 (03) 318-325
    CrossrefPubMedGoogle Scholar
  • 53 Lindau ST, Abramsohn EM, Bueno H. et al. Sexual activity and counseling in the first month after acute myocardial infarction among younger adults in the United States and Spain: a prospective, observational study. Circulation 2014; 130 (25) 2302-2309
    CrossrefPubMedGoogle Scholar
  • 54 Xu F, Ming Q, Hou L. The effect of sex counselling in the sexual activity of acute myocardial infarction patients after primary percutaneous coronary intervention. Acta Cardiol 2015; 70 (04) 460-464
    CrossrefPubMedGoogle Scholar
  • 55 Lindau ST, Abramsohn E, Bueno H. et al. Sexual Activity and Function in the Year After an Acute Myocardial Infarction Among Younger Women and Men in the United States and Spain. JAMA Cardiol 2016; 1 (07) 754-764
    CrossrefPubMedGoogle Scholar
  • 56 Steinke EE, Wright DW. The role of sexual satisfaction, age, and cardiac risk factors in the reduction of post-MI anxiety. Eur J Cardiovasc Nurs 2006; 5 (03) 190-196
    CrossrefPubMedGoogle Scholar
  • 57 Gao L, Yang L, Qian S, Li T, Han P, Yuan J. Systematic review and meta-analysis of phosphodiesterase type 5 inhibitors for the treatment of female sexual dysfunction. International Journal of Gynecology & Obstetrics 2016; 133 (02) 139-145
    CrossrefPubMedGoogle Scholar