Erectile Dysfunction (ED) is defined as the inability for a man to attain and maintain an erection rigid enough for intercourse. Men can experience this problem at any age and for various reasons.
During assessments it is important to talk about this with men and their wives or partners. It is always better to incorporate them in the conversation. As men age, the problem is most often due to poor blood flow, and this pattern is known as vasculogenic ED. Vasculogenic ED is often the very first sign of a change in cardiovascular health and precedes the onset of a significant cardiovascular event, such as a heart attack, by five years. When ED symptoms begin it gives doctors the opportunity to address their patients’ cardiovascular risk factors and prevent serious health issues.
What is the link between erectile dysfunction and heart disease?
An erection happens when stimulation triggers nerve signals to the blood vessels in the penis. Cells that line the blood vessels, called endothelial cells, respond by producing nitric oxide. This causes the blood vessels to dilate and allow enough blood to flow into the penis to produce an erection. When the endothelial cells that line the arteries are damaged by factors like diabetes, hypertension, or smoking, the blood vessel loses its elasticity and blood flow is impaired. The result is a progressive decline in a man’s ability to attain and maintain a rigid erection. Endothelial dysfunction is also the first step in the buildup of cholesterol plaque in the coronary arteries and is the link between ED and cardiovascular disease.
Studies linking erectile dysfunction with cardiovascular risk show the strongest association with younger men in their 40s and 50s. These men may not have any symptoms like shortness of breath or chest pain when they exert themselves and may not think that they are at risk. Men presenting with ED should have an assessment of the common risks for cardiovascular disease like high blood pressure, elevated cholesterol levels, diabetes, and smoking. This information can be used to estimate their risk of a cardiovascular event, and if their risk is elevated, they should have additional testing.
According to Mark Paulos, MD, a test called coronary artery calcium score can be performed to detect the buildup of cholesterol plaque in the blood vessels in the heart before it has progressed enough to cause symptoms. If cholesterol plaque is present, men can adopt healthy lifestyle changes to stop the progression of the problem. If the cholesterol plaque is extensive, men should be evaluated by a cardiologist and management may include the addition of medication like a statin or aspirin.
The association between erectile dysfunction and cardiovascular risk is also seen in men with diabetes and in men with pre-existing cardiovascular disease. These men should also be routinely screened for changes in sexual function.
Can erectile dysfunction and heart disease be prevented?
Lifestyle choices matter
Healthy lifestyle choices can have an impact. Eating a nutritious diet, exercising regularly, avoiding smoking, and controlling high blood pressure, high cholesterol, and diabetes can reduce the risk of heart attack and stroke and might improve sexual function in the process. These changes include:
- Incorporating more plants in your diet or moving to a plant-based diet
- It is important to get the amount of daily exercise.
- Creating and maintaining a healthy sleep routine
Can I take erectile dysfunction medications if I have heart disease?
Men with cardiovascular disease are more likely to experience sexual dysfunction. While lifestyle changes are the foundation for treating heart disease and improving sexual health, some patients may need medications to assist with their erectile dysfunction. The good news is that medications commonly used to treat this condition are safe to use even after having a cardiovascular event.
More recent studies suggest that medications for erectile dysfunction may even help to improve cardiovascular health and reduce risk for cardiovascular events. Men who are having symptoms, such as shortness of breath or chest pain, should always be evaluated before starting treatment for erectile dysfunction, and all men should check with their doctor about drug interactions before starting a new medication.
Disclaimer: The information provided in this blog post is for educational purposes only and should not be considered as medical advice. Please consult with a healthcare professional to discuss your specific situation and determine the most appropriate treatment options for your condition.
Hugo Aguirre, MD
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