Beyond Sex: Erectile Dysfunction Could Spell Heart Trouble
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Judging by the ubiquity of ads touting drugs that treat erectile dysfunction, or ED, marketing campaigns would have you believe that 21st-century medicine has revolutionized modern men's sexual performance, improved couples' romantic lives and all but eradicated a disorder that was once only whispered about.
But what TV commercials tend to leave out is that ED has an even darker side: It can herald cardiovascular trouble.
Furthermore, ED – defined as the inability to achieve or maintain erection for satisfactory sexual intercourse – is very common, affecting 40 percent of men older than 40 and 70 percent of those over 70. Yet relatively few men seek help for this.
ED: It's Not All in Your Head
Stress often gets the blame for most cases of ED, hence the sometimes erroneous assumption that once the demands of modern life subside, "things" will invariably get back to normal. While anxiety, depression and stress can all contribute to ED – a condition known as psychogenic ED – it can also signal the presence of more ominous medical conditions, including pelvic trauma, nervous system disorders and diseased arteries. The latter, known as vascular ED, is the most common nonpsychogenic form of ED.
Complicating matters further, ED often stems from several factors, and determining the main driver can be challenging. For example, a history of sexual frustration caused by an underlying organic disorder can lead to feelings of anxiety in subsequent sexual encounters, fueling a vicious feedback loop.
ED and Your Heart
Vascular ED stems from poor blood flow inside arteries that have been hardened and narrowed by the buildup of fat and calcium deposits – a condition known as atherosclerosis, the main culprit behind heart attacks and strokes. Another cause of vascular ED is a condition known as endothelial dysfunction, which is marked by the inability of blood vessels to relax properly. The condition is caused by the insufficient release of an all-important chemical called nitric oxide, which is needed for blood vessel relaxation, the underlying mechanism of erection. Atherosclerosis and endothelial dysfunction are closely related processes that are both fueled by smoking, lack of physical activity, obesity, diabetes, high blood pressure and high cholesterol, all well-known players in cardiovascular disease.
This is why vascular ED can often signal the presence of processes that also lead to heart attack and stroke.
A 2013 Australian study of 95,000 men with no known heart problems found that those with severe ED had a 60 percent higher risk of developing heart disease and nearly twice the risk of dying compared with those without ED. Other studies have reaffirmed these findings. Research published earlier this year also showed a link between ED and dementia, a condition that often stems from diseased blood vessels in the brain.
Experts estimate that more than 40 percent of men with ED and risk factors for cardiovascular disease are unaware of their heart risk.
A study published this year in The Journal of Sexual Medicine estimated that screening men with ED for cardiovascular disease risk would be a cost-effective strategy that would not only help avert heart attacks and strokes, but would also save more than $21 billion in health care expenses over 20 years in the United States alone.
Because of the shared risk factors with cardiovascular disease, a diagnosis of vascular ED can signal the presence of atherosclerosis in other vessels, including the arteries of the heart. And the presence of atherosclerosis in those vessels boosts the risk of heart attack or stroke.
Thus, a diagnosis of vascular ED should be heeded as a warning bell, an alarm signaling there may be something wrong in the arteries.
An Ounce of Prevention
Although ED is often deemed a normal consequence of aging, both atherosclerosis and endothelial dysfunction are abnormal processes that can occur at almost any adult age. Most importantly, they can be prevented.
Vascular ED is fueled by the same factors that lead to cardiovascular damage, so preventing either takes the exact same approach – a healthy lifestyle, marked by a good diet, regular exercise, no smoking and maintaining normal blood pressure, cholesterol and weight.
I Already Have ED. Now What?
Tell your doctor. Social progress notwithstanding, ED still carries a stigma that can deter some men from discussing this problem. But being at the doctor's office is no place to be bashful. Speak up and let your physician know about it. After all, there's more at stake than your sex life. Your doctor will help determine the underlying cause of ED and, if necessary, refer you to a specialist for treatment.
A culprit in the medicine cabinet? Some medications used to treat depression and high blood pressure can cause or exacerbate ED. Certain drugs used to treat heart disease, called nitrates, can make for a dangerous mix when used with an ED medication, as the combination can lead to a precipitous drop in blood pressure.
Get screened for heart disease. ED may be the very first warning sign of cardiac trouble, even in the absence of other heart-related symptoms.Men with ED and no obvious causes, such as pelvic or neurologic disease, should be evaluated for underlying heart disease before starting ED treatment.
Know your cardiovascular risk score. ED symptoms often precede the onset of heart symptoms by at least two years, so the detection of ED offers a window to intervene and stop cardiac disease in its tracks. What this means is that even in the absence of heart disease signs, you should have your cardiovascular risk score calculated and managed accordingly. Your physician will determine your 10-year risk for suffering a heart attack or stroke by using a formula that factors in your age, gender, blood pressure, cholesterol levels, smoking and any conditions that drive up that risk, such as diabetes.
Better performance through healthier lifestyle. Patients at high risk for cardiovascular disease may benefit from treatment with cholesterol-lowering statin medications. Regardless of drug treatment, research shows that adopting a healthy lifestyle can also improve ED symptoms and at the same time reduce the risk of heart attacks and strokes.
The Eight Pillars of ED Prevention
Quit smoking. Smoking worsens the function of the cells that line the walls of the arteries, and inflammation contributes to atherosclerosis. Nicotine causes blood vessels to constrict, which can reduce blood flow to the penis.
Exercise regularly. Physical activity can reduce cardiovascular risk, lower stress and improve blood flow.
Eat your way to a healthier heart and better sex life. The same diet that is good for the heart can also prevent ED. Opt for a menu rich in fruits, vegetables, lean protein and legumes, and low in processed and fatty foods.
Maintain normal body weight. Being overweight can cause or worsen ED. Having a waist circumference above 40 inches is associated with lower testosterone, the main male sex hormone.
Control blood pressure and cholesterol levels. These factors are not merely harbingers of heart attack and stroke – they can also cause sexual dysfunction.
If you have diabetes, keep your blood sugar in check. At least half of men with diabetes experience ED symptoms. Controlling blood sugar can help prevent ED and improve symptoms in men who already have ED.
Limit alcohol. You might think that alcohol might get you in the mood, but overindulging can limit sexual performance.
Manage anxiety and stress. Talk to your doctor about healthy ways to manage stress and boost mental health. Consider seeing a mental health expert if things don't get better.