Copyright © 2004 by the European Society of Cardiology.
Letter to the Editor
ß-Blockers and sexual problems
Department of Cardiology, Thoraxcenter, University Hospital Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
University of Kentucky, College of Nursing, USA
* Tel.: +31-50-3612355; fax: +31-50-3614391
E-mail address: t.jaarsma{at}thorax.azg.nl
Dear editor in chief
With great interest we read the article of Silvestri et al.,1 in which they reported that the occurrence of erectile dysfunction (ED) after therapy with ß-blockers is low and a placebo is effective in reversing ED in these patients. They also described that knowledge of patients about side effects of ß-blocker was related to the occurrence of ED in patients using ß-blockers. The authors describe a two phase study in 96 male patients, 90 days after using atenelol; one-third of patients did not know what the drug was, one-third did not know the side effects of atenelol and one-third were told the side effects. In the first phase Silvestri et al.1 described the occurrence of ED and in a second phase they randomised the 16 patients with ED into placebo or Sildenafil therapy. The authors conclude that knowledge and prejudice about side effect of ß-blockers can produce anxiety that may cause ED. This conclusion, however, should be interpreted with caution and the wording of this conclusion might be somewhat overstated.
First, there are some methodological questions that remain unanswered after reading the paper: the number of patients in the study was very small (
), divided over three groups and it is not clear if these groups were created by random assignment. The authors also mention anxiety as an underlying reason for ED, although anxiety was not measured.
Although the authors found no statistical difference in clinical characteristics, more patients in the ‘atenelol-know side effects’ group had diabetes and hypertension compared to the ‘atenelol-do not know side-effects group’ and atenelol-do not know drug group’. It is known that patients with diabetes and hypertension are known to have more often ED.2 In addition, patients often find it difficult to discuss this ED due to embarrassment or to ignorance about such problems. By providing the opportunity to discuss ED and ‘blame it to a pill’ in the ‘atenelol-know side effects’ group patients might have felt more at ease in admitting this problem, which could have biased the results.
Second, the authors were not clear on defining ED related to use of ß-blockers. Impotence is described as side effects of ß-blocker and can mean minimal, moderate and complete impotence. This makes it hard to establish how serious the problem is. If the authors mean complete ED, 16% is actually a rather considerable incidence and higher if compared to a general population.3
It is known that many cardiac patients suffer from sexual problems, either caused by fear and anxiety, side effects of meditation or both.4 Despite the frequency of occurrence of sexual problems among cardiac patients and their need to have these issues addressed, sexual issues are rarely discussed by clinicians. Regardless of their origin, these problems need to be discussed.4 The article of Silvestiri et al. suggests that patients might benefit if health care providers withhold information from patients about the potential sexual side effects of medications. This conclusion is quite ill-advised and gives health care providers grounds to ignore this important but already under addressed problem area.
References
- Silvestri A, Galetta P, Cerquetani E, Marazzi G, Patrizi R, Fini M et al. Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo. Eur. Heart J. 2003;24:1928–1932.
[Abstract/Free Full Text] - Greenstein A, Chen J, Miller H, Matzkin H, Villa Y, Braf Z. Does severity of ischemic coronary disease correlate with erectile function? Int. J. Impot. Res. 1997;9(3):123–126.[CrossRef][Web of Science][Medline]
- Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study. J. Urol. 1994;151:54–61.[Web of Science][Medline]
- Taylor HA. Sexual activity and the cardiovascular patient: guidelines. Am. J. Cardiol. 1999;84:6N–10N.[CrossRef][Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||