* A significant proportion of men with
erectile dysfunction (ED) exhibit early signs of
coronary artery disease (CAD), and this group may develop more severe CAD than men without ED (Level 1, Grade A). * The time interval among the onset of ED symptoms and the occurrence of CAD symptoms and cardiovascular events is estimated at 2-3 years and 3-5 years respectively; this interval allows for risk factor reduction (Level 2, Grade B). * ED is associated with increased all-cause mortality primarily due to increased cardiovascular mortality (Level 1, Grade A). * All men with ED should undergo a thorough medical assessment, including
testosterone, fasting
lipids, fasting
glucose and blood pressure measurement. Following assessment, patients should be stratified according to the risk of future cardiovascular events. Those at high risk of
cardiovascular disease should be evaluated by stress testing with selective use of computed tomography (CT) or coronary angiography (Level 1, Grade A). * Improvement in cardiovascular risk factors such as
weight loss and increased physical activity has been reported to improve erectile function (Level 1, Grade A). * In men with ED,
hypertension, diabetes and hyperlipidaemia should be treated aggressively, bearing in mind the potential side effects (Level 1, Grade A). * Management of ED is secondary to stabilising cardiovascular function, and controlling cardiovascular symptoms and exercise tolerance should be established prior to initiation of ED
therapy (Level 1, Grade A). * Clinical evidence supports the use of
phosphodiesterase 5 (
PDE5) inhibitors as first-line
therapy in men with CAD and comorbid ED and those with diabetes and ED (Level 1, Grade A). * Total
testosterone and selectively free
testosterone levels should be measured in all men with ED in accordance with contemporary guidelines and particularly in those who fail to respond to
PDE5 inhibitors or have a
chronic illness associated with low
testosterone (Level 1, Grade A). *
Testosterone replacement
therapy may lead to symptomatic improvement (improved wellbeing) and enhance the effectiveness of
PDE5 inhibitors (Level 1, Grade A). * Review of cardiovascular status and response to ED
therapy should be performed at regular intervals (Level 1, Grade A).