Copyright © 2004 by the European Society of Cardiology.
Letter to the Editor
Beta-blocking agents and erectile dysfunction after acute myocardial infarction: guilty or innocent?
Zerbini Foundation, InCor-DF, Department of Medicine, SQSW 304 Bloco D ap 505, 70673-404 Brasilia, DF, Brazil
* Tel.: +55-613616585; fax: +55-612330263
E-mail address: lvacanti{at}cardiol.br
We read with interest the paper by Silvestri et al.1 on the report of erectile dysfunction (ED) after therapy with beta-blockers. An acknowledged preliminary look at an important topic. The author found that the incidence of ED was 3% in the group not knowing which drug they were taking, 16% in the group knowing that they were receiving a beta-blocker and 31% in the group also knowing the side effects of the drug (
). I agree when they suggests that report of ED in patients receiving beta-blockers may be mostly psychological in origin. We also presented at ESC Congress 2002 the study: Beta-blocking agents and erectile dysfunction after acute myocardial infarction: guilty or innocent?2 We surveyed 37 male patients that prior to the AMI had an active sexual life, without ED. They filled out two questionnaires: The International Index of Erectile Function (IIEF – Erectile Function – a summation of Questions 1–5) and the Self-Report Questionnaire (SRQ) that was developed by the WHO for the screening of diseases, such as anxiety-related disorders and depression.3 A ranking higher than or equal to seven signaled "mental distress." Of them, 91% reported resumption of sexual activity after AMI. After six months, 15 (40%) presented with ED, with a mean score of 14.7 (IIEF). Of nine patients with distress, eight presented with erectile dysfunction and of 28 without distress, 7 presented with erectile dysfunction (89%x25%, 
). Distress was a associated variable of erectile dysfunction postinfarction and we did not detect a difference with regard to the incidence of ED among the groups with or without beta-blockers (36%x55%, 
). Distress may reduce erotic focus and therefore reduce psychogenic incitement, thereby interfering with the normal sexual cycle, jeopardizing male erection. Furthermore, by means of brain signals, psychological problems may also inhibit the parasympathetic activation or aggravate the sympathetic response, influencing the sexual normal cycle of men.4 Also, erectile dysfunction in hypertensive individuals may be related more to hypertension level than to drug treatment and beta-blocking agents is not more likely to be associated with sexual dysfunction than placebo.5
References
- Silvestri A, Galetta P, Cerquetani E et al. Eur. Heart J. 2003;24:1928–1932 Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo.
[Abstract/Free Full Text] - Vacanti LV, Caramelli B. Erectile dysfunction after myocardial infarction and beta-blockers agents: guilty or inoccent? Eur. Heart J. 2002;23(Suppl):441.
[Free Full Text] - WHO-Division of Mental Health: A user's guide to the self-reporting questionnaire (SRQ). Geneva, Switzerland. Draft; 1994. p. 1–64.
- Friedman S. Cardiac disease, anxiety, and sexual functioning. Am. J. Cardiol. 2000;86(Suppl 2A):46F–50F.[Web of Science][Medline]
- Grimm RH Jr., Grandits GA, Prineas RJ et al. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS) Hypertension. 1997;29:8–14.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||