Heart rate recovery, cardiac rehabilitation, and erectile dysfunction in males with ischemic heart disease.

To the Editor,

I have read the article entitled “Heart rate recovery, cardiac rehabilitation, and erectile dysfunction in males with ischemic heart disease” by Kałka et al. (1) with great interest, which was recently published in Anatolian Journal of Cardiology 2016; 16: 256-63. The investigators reported that in patients with ischemic heart disease (IHD) and erectile dysfunction (ED) subjected to cardiac rehabilitation, enhancement of autonomic balance assessed using heart rate recovery (HRR) plays a significant role in the mechanism of improvement in erection quality (1). Authors have reported that there was no significant difference with regard to beta-blocker therapy (1).

Beta-blockers are one of the most commonly used and cornerstone therapy in the treatment of ischemic heart disease (2). Nebivolol is a third-generation beta-blocker, and has a vasodilating effect that is attributed to the generation of endothelial nitric oxide, in addition to β1-adrenoceptor selectivity (3).

It is well known that beta-blocker therapy effect might be different with regard to ED depending on sort of it in patients with IHD (4). Aldemir et al. (4) have reported that although ED in males undergoing CABG surgery decreases when metoprolol is used, nebivolol had a protective effect on the sexual activity of men undergoing coronary artery bypass surgery with cardiopulmonary bypass. In addition, Brixius et al. (5) have reported beneficial effects of nebivolol on the erectile function in hypertensive men.

I would like to emphasize one important point to clarify in this article. Kind of beta-blocker therapy is very important to evaluate ED in patients with IHD (3–5). Therefore, authors should mention kind of beta-blocker therapy used in this study group.

In conclusion, ED is more common in men with IHD. Nebivolol, a third-generation beta-blocker, seems to have beneficial effects on ED compared with metoprolol (3–5). Kind of beta-blocker therapy might affect ED in patients with IHD.