By now, men have probably heard that erectile dysfunction (ED), which the National Institutes of Health defines as the "inability to get or keep an erection firm enough" to do the deed, isn't just an emasculating sexual problem. It's also increasingly being recognized as a sign that something could be amiss in the cardiovascular department. New research adds more.
Research on over 1,500 men published this week in the journal Circulation suggests that for those who have cardiovascular disease, ED is a "potent predictor" of serious trouble ahead: Having both appears to raise the chance of dying from any cause and of dying from cardiovascular disease, and it seems to double the risk of having a heart attack compared with men with cardiovascular disease but no erectile issues. What's more, the researchers reported, the worse the ED, the greater those risks appear to be.
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"We've known from previous studies that men who present with ED are at greater risk of going on to have cardiac events such as heart attack, cardiac death, stroke, and angina [chest pain]," says Robert Kloner, director of research at Good Samaritan Hospital's Heart Institute and a professor of medicine at the University of Southern California (who had no hand in the latest research). "We've also known that typically, ED comes on before the cardiac symptoms, usually by three to four years." What the new study adds, he says, is that ED may help flag men whose cardiovascular disease is more advanced and who are in greater peril.
[For more on this new study, read about erectile dysfunction and risk of death.]
What do erections have to do with gauging cardiovascular health? "An erection is a vascular phenomenon," says Kloner. While there are many causes of ED, it's most often the result of a vascular issue preventing enough blood from getting where it needs to go, says Kloner. "ED may be a marker of longer-standing atherosclerosis," he explains, and it is also a marker of endothelial dysfunction (often a precursor to atherosclerosis), in which blood vessels fail to open up as they should. One idea as to why ED may precede heart problems, says Kloner, is that the small arteries supplying the penis may get plugged up with plaque and manifest as ED before larger heart arteries get clogged enough to cause symptoms.
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All this is why men shouldn't brush off erectile problems as bedroom bungles and should discuss them with their doctor. "Men need to consider ED as a risk factor for cardiovascular disease just as high blood pressure and cholesterol are," Michael Bohm, lead author of the Circulation study and chairman of internal medicine in the department of cardiology and intensive care at the University of Saarland, Germany, was quoted as saying in a recent American Heart Association news release.
While ED may have other culprits, says Kloner , when a man walks into a doctor's office complaining of erectile problems, doctors should think, "Aha! Could this patient have cardiovascular risk factors?" Does he have high blood pressure? Does he have high levels of "bad" cholesterol and low levels of "good"? Is he a smoker? Does he have diabetes? Is he obese and physically inactive? "The main message," adds Roger Blumenthal, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, is to discover heart risk factors and control them early on.