Urology pearls: Erectile dysfunction and your heart

Shahar Madjar, MD

In this article, I wanted to tell you about erectile dysfunction and its association with diseases of the heart and blood vessels. You will learn that erectile dysfunction isn’t just a condition that affects the quality of life of a man and his sexual partner; it might also be a marker for a serious process affecting a man’s heart and blood vessels.

In a Urology textbook, edited by Dr. D.R. Smith and published in 1966, I found the following: “… with few exceptions, the causes of sexual difficulties [in men] are psychic… based on guilt, jealousy, or frigidity on the part of wife… Many of these men are obviously tense and nervous… Unless the patient’s difficulties are of short duration, he should be referred to a psychiatrist.”

The thing about medicine, and about urology in particular, is that it is ever changing. Ideas appear, like clouds in the sky, then disappear, to make room for other ideas. And as doctors and researchers make progress, the true nature of how the body functions, and fails to function, become evident. The field of urology which deals with erectile function and erectile dysfunction is no exception. And so, urologists and researchers no longer believe that erectile dysfunction is “all in your head.” They don’t even believe that its all in your penis. Instead, I now know, as many other urologists will admit, that erectile dysfunction is in most cases a vascular disease–or a disease caused by narrowing and dysfunction of the blood vessels supplying the penis.

What is erectile dysfunction? Several definitions exist, but perhaps the simplest is the best: erectile dysfunction is the inability to attain or maintain an erection sufficient for sexual performance.”

Erectile dysfunction is a common medical condition. More than 50% of men have erectile dysfunction. It appears in young men too, but the prevalence of erectile dysfunction increases as men age. The ‘“Rule of Tens” applies: with every passing decade of life, the prevalence of erectile dysfunction increases by ten percent. And so, at age 20, your chances to have ED is roughly 20%. The chances increase to about 40% at 40, roughly 70% at 70, and, if you were lucky to reach 100, the chance you will have erectile dysfunction is practically 100%. These numbers apply for all levels of erectile dysfunction, be it mild, moderate, or severe. Severe erectile dysfunction is less prevalent, but it is common enough with its prevalence tripling from 5% at age 40 to 15% at 70.

How is erectile dysfunction a marker for coronary artery disease? The association was first noted in an Italian study published in 2003. Piero Montorsi and his colleagues looked at 300 men with acute chest pain and coronary artery disease (narrowing of the arteries supplying the heart). They found that 49% of these men had erectile dysfunction as well. Perhaps even more interesting, in 67% of these men (who had both conditions), erectile dysfunction appeared on an average of 38.8 months before the onset of their chest pain. The researchers suggested that erectile dysfunction may serve as a warning sign–a canary in the coal mine–for coronary artery disease.

This correlation just made sense. First, men of similar age were affected by both coronary artery disease and erectile dysfunction. And then, both conditions shared the same risk factors: high cholesterol levels, smoking (or history of smoking), hypertension, diabetes, obesity and sedentary life style. In other words, what isn’t good for your penis, can’t be good for your heart (or vice verse, whichever you prefer).

And further evidence, indicating that correlation, came along shortly thereafter. In a review of 14 different studies, Vlachopoulos and his colleagues found that the presence of erectile dysfunction increased the risk of future heart attacks (by 62%), strokes (by 39%), and mortality in general (by 25%).

The same Italian group that noticed the correlation in the first place came up with an appealing explanation they called The Artery Size Hypothesis. According to Montorsi, the effect of aging, and that of other risks factors will take place in all blood vessels. But the rate in which the symptoms occur will depend on the size of the arteries supplying the organ. The smaller the artery, the sooner it will be narrowed, and the sooner symptoms will appear. Because the arteries supplying the penis are smaller than those supplying the heart, erectile dysfunction will appear sooner than chest pain and heart attacks.

What should a man with erectile dysfunction do to regain his erections, to prevent heart attacks and strokes, even death? I will tell you more in my next article.

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.


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