Erectile dysfunction, once thought to have primarily psychological causes, is now recognized to often stem from physiological problems such as poor blood flow to the penis. Increasingly, research indicates that ED can be an early warning sign of coronary artery disease, which also results from obstructed blood flow and, if untreated, can lead to heart attacks and stroke. Recent studies—including two published online today—also link sagging erections to diabetes, which has negative effects on cardiovascular health. More than half of American men age 40 to 70 suffer from erectile dysfunction, so that's a lot of men who may be at risk of vascular disease—and may not realize it.
"Symptoms of erectile dysfunction seem to occur three to four years before symptoms of coronary artery disease," says Robert Kloner, a cardiologist at Keck School of Medicine in Los Angeles, Calif. Researchers first started tracking a link between erectile dysfunction and cardiovascular problems in the mid-'90s, and in the last few years they have recognized that erectile dysfunction precedes and is therefore predictive of future cardiovascular problems.
"Patients should not [ignore] the presence of erectile dysfunction. And physicians should always investigate the presence of ED in high-risk patients," notes Carmine Gazzaruso, that study's author and a professor at the University of Pavia in Italy. In 2005, leading physicians published a consensus statement that every man who reports having erectile dysfunction without an obvious cause should be screened for vascular disease.
In diabetics, it turns out, ED may be even more of a red flag than it is in other men. Two new studies published today in the Journal of the American College of Cardiology suggest that men with both diabetes and erectile dysfunction face a greater cardiovascular risk than men with erectile dysfunction alone. "It's a real wake-up call for men with both erectile dysfunction and diabetes," says Allen Seftel, a urologist at Case Western University. In light of the new findings, he says, diabetics who develop ED should be especially prompt about seeking medical attention and getting tested for cardiovascular disease.
One of the studies, led by Gazzaruso, tracked diabetic men with silent (symptomless) coronary artery disease for several years. It found that those who initially had erectile dysfunction were more likely to experience a major cardiac event such as a heart attack than those who didn't. In the ED-affected group, 61.2 percent had a major heart problem during the four-year study. By comparison, 36.4 percent of men who didn't have erectile dysfunction had major heart problems.
The other study, conducted by researchers in Hong Kong, followed 2,306 men with diabetes without cardiovascular problems for an average of four years, finding that men who had erectile dysfunction had about a 60 percent higher risk of developing cardiovascular problems such as heart attack, heart failure, and chest pain. "Even mild symptoms of erectile dysfunction can mean your glucose, blood pressure, and lipid levels are very abnormal," says Peter Tong, a professor at the Chinese University of Hong Kong and the author of the study.
Making some simple changes, experts say, might save a man's life—not just his sex life. Men with erectile dysfunction—especially those who also have diabetes—need to be especially vigilant about finding ways to eat a healthy diet, exercise regularly, and abstain from smoking. A 2004 study found that men who started exercising in midlife had a 70 percent reduced risk of erectile dysfunction relative to men who remained sedentary. In that study, about a third of obese men with erectile dysfunction had regained their sexual function after two years. "Getting off the couch will not only reduce the risk of diabetes and cardiovascular disease, but it can also prevent erectile dysfunction," says Elizabeth Selvin, a Johns Hopkins researcher. Last year, Selvin found men who were physically inactive were much more likely to have ED than men who were active.
The most important thing for men, however, is simply to get to the doctor if they have erectile dysfunction. "A lot of men still don't feel comfortable talking to their doctor about it," says Kloner. Yet avoiding the doctor might mean passing up access to powerful medications that can help counteract flagging erections and clogging arteries. For example, a class of drugs called PDE5 inhibitors—which includes Viagra (which just celebrated its 10th birthday), Levitra, and Cialis—can help men achieve erections by increasing blood flow to the penis, while statins, if used appropriately, can lower LDL cholesterol levels. The Italian study found that the cholesterol-lowering medications could cut the risk of hear problems by a third, and it hinted that PDE5 inhibitors might have a protective effect as well.
We'd like to know: If you've ever told a doctor you had ED, did the doctor then test you for cardiovascular disease or diabetes?