15 février 2007

Insister sur l'impuissance comme effet au tabagisme

Extrait de Medscape:

Tobacco use is well-known to be a significant health concern. Nevertheless, millions of men and women around the world continue to use tobacco products. Most antitobacco education and advertising efforts have focused on the traditional warnings of lung cancer, heart disease, and pregnancy complications. However, in the last two decades, the link between smoking and impotence has been described by various authors. Despite this, impotence is not well recognized by the general public or even by general practice medical providers as a potential consequence of smoking. Pharmacists and other health professions are missing an opportunity to teach smokers about another good reason to kick the habit.

Literature regarding smoking and impotence describes various mechanisms for the link. McVary et al. published a comprehensive review in 2001 that examined clinical and scientific studies. The investigators found evidence that impotence can be caused directly by smoking-induced reductions in nitric oxide concentrations, which impair endothelium-dependent relaxation of arteries, and indirectly by smoking-induced atherosclerosis.

Unfortunately, not only does smoking tobacco appear to increase impotence risk, data suggest it also predicts a poor response to popular pharmacologic treatment for impotence. Park et al. found that current smoking was significantly associated with sildenafil failure in men over the age of 60 years suffering from impotence. The lack of effect was likely due to the failure of sildenafil to potentiate endogenous nitric oxide-mediated vascular responses—responses that are reduced in smokers. Since all phosphodiesterase inhibitors, such as sildenafil, exert their effect through nitric oxide modulation, this therapeutic failure may be a class effect.

On the basis of the association between smoking and impotence and data supporting the benefits of smoking cessation on impotence, it seems logical that this topic be included in smoking-cessation programs. Moreover, data support that there is a need for this information to be communicated to smokers, as a majority of men appear to be unaware that smoking increases ED risk.

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