Continuing Medical Education Erectile Dysfunction , Depression , and Ischemic Heart Disease : Does the Existence of One Component of This Triad Necessitate Inquiring the Other Two ?

Introduction. Erectile dysfunction (ED) depression and ischemic heart disease (IHD) had long been classified as independent medical conditions managed by unrelated medical services. Recent studies have revealed the intimate associations among the three conditions. However, when a patient presents with one component of this triad, whether the physicians should also screen for the other two components is still an important question to be answered. Aim. The purpose of this Continuing Medical Education article is to review contemporary knowledge regarding the reinforcing associations between the three conditions and to highlight the importance of screening for the other two components when a patient presents with one component of this triad, thus enabling best-practice management. Methods. An English-language MEDLINE review was performed from 1990 to present-day for the association between ED, depression and IHD. Main Outcome Measure. Current state of information regarding associations among the three conditions. Results. Recent studies have established a new paradigm for the intimate associations among the three conditions. Furthermore, various risk factors and medical co-morbidities such as age, obesity, sedentary lifestyle, smoking, heart disease, hypertension, dyslipidemia, diabetes, and related medications have been demonstrated to be highly associated with psychological disorders, cardiovascular diseases, and sexual dysfunctions. Conclusions. The integrative view and holistic approach with full consideration of the property of each condition is the appropriate way for the diagnosis and management of patients with these conditions. El Sakka AI. Erectile dysfunction, depression, and ischemic heart disease: Does the existence of one component of this triad necessitate inquiring the other two? J Sex Med 2011;8:937–940. A 62-year-old married man presented to our institution with persistent erectile dysfunction (ED) of 2 years’ duration. He was known to have type 2 diabetes mellitus and on oral hypoglycemics, antihypertensives, and lipid-lowering agents for more than 5 years. His erectile function domain scores of the International Index for Erectile Function revealed that he had severe ED (score = 8). No abnormality was detected on his focused genital examination. The resident urologist consulted his senior colleagues who advised him to order laboratory investigations in addition to testosterone and prolactin assessment and refer him to a cardiologist for cardiac assessment. This management approach raised concern from the residents on service, who wondered whether there was a significant association between ED and ischemic heart disease (IHD). Additionally, they questioned whether it was necessary to refer all patients with ED to a cardiologist for assessment. At the patient’s next appointment the cardiac consultation report revealed that the patient had silent IHD that necessitated further coronary artery assessment. Moreover, the cardiologist mentioned that the patient had depressive symptoms, and he suggested that the patient be referred for a psychiatric evaluation. At this point, more quesJ Sex Med 2011;8:937–940 937 Continuing Medical Education tions emerged regarding the relationship between ED, IHD, and depression from the house staff. Over the next few months, his ED (treated with phosphodiesterase type 5 inhibitors), depression effectively managed with an selective serotonin reuptake inhibitors (SSRIs), and his cardiac concerns were effectively treated. The issue and controversy related to optimal management of patients with multiple comorbidities remains a clinical quagmire, one on which this CME review is focused.