Erectile Dysfunction

A publication covering topics related to cardiovascular health has published results of a study that suggests that there's a strong link between erectile dysfunction (ED) and the risk of a cardiovascular event such as a heart attack or a stroke.

The Linkage Between ED and CVD

It's not new information that ED — the inability to gain and maintain an erection firm enough for sex — can be a sign of high risk for cardiovascular disease (CVD). In fact, the two conditions share many of the same risk factors, including:

• diabetes
• tobacco use
• alcohol use
• high blood pressure
• high cholesterol
• age
• obesity
• low testosterone

It's not difficult to see generally where the connection comes from. Both conditions are related to difficulties in circulatory function, where one tiny change can have major effects on the operation of various systems in the body.

ED affects approximately 20 percent of men over 20 years old, while cardiovascular disease is the leading cause of death in the United States. It's estimated that at least one in every four people in the U.S. will experience a cardiovascular event at one point in their life.

This brings us back to the aforementioned study, first published as a research letter in Circulation, the American Heart Association's research journal.

How Was the Study Carried Out?

As part of ongoing research about atherosclerosis, the building in plaque in the blood vessels of the human body, this particular study followed a population of almost 2,000 men, aged 60 to 78, over four years. Subjects were surveyed at the beginning and at the end of this four-year period and asked questions about their health.

The results were, broadly, that the subjects who reported suffering from ED were twice as likely to experience a cardiovascular event during the four years studied. More specifically, there were 115 reports of CVD during the four-year period. Those reports came from men with ED at slightly over a 2 to 1 ratio over men without ED.

Here are some of the studies highlights:

• Out of the entire population of over 1,900 participants, 115 people reported suffering from fatal or non-fatal heart attacks, fatal or non-fatal strokes, cardiac arrests, and cardiac deaths.

• Out of the people that reported CVD during this time period, 6.3 percent had reported suffering from ED, compared to 2.6 who hadn't.

• Even after adjusting for other risk factors, there was still significant evidence to tie the two factors together

According to Michael Blaha, M.D., M.P.H., associate professor of medicine at the Johns Hopkins School of Medicine and the senior investigator for this particular study:

"Our results reveal that erectile dysfunction is, in and of itself, a potent predictor of cardiovascular risk... Our findings suggest that clinicians should perform further targeted screening in men with erectile dysfunction, regardless of other cardiac risk factors and should consider managing any other risk factors — such as high blood pressure or cholesterol — that much more aggressively."

How the Results Affect Our Knowledge

Although this study seems to confirm what the medical community suspected about links between ED and cardiovascular disease, the actual information has already been put into practice as a way to assess cardiovascular risk in men. In a risk-scoring algorithm put into place by physicians in the United Kingdom, the presence of ED is already being used as one of a variety of signs that are used to formally assess a patient's risk of CVD over the next 10 years.

The Mayo Clinic is already well aware of this connection as well:

"Erectile dysfunction — the inability to get and keep an erection firm enough for sex — can be an early warning sign of current or future heart problems. Likewise, if you have heart disease, getting the right treatment might help with erectile dysfunction."

The Mayo Clinic poses a few explanations for the linkage not addressed in the above study, however. While it was previously thought that ED preceded CVD due to atherosclerosis leading to decreased blood flow in the penis, the suspected cause for this linkage has shifted. The medical community now believes these conditions are tied together due to dysfunction of the endothelium — the inner lining of the blood vessels — causing insufficient blood flow to the heart and other organs, which causes ED, CVD, and atherosclerosis.

In conclusion, the study published in Circulation confirmed much of what we already suspected, but importantly, highlighted the need to remain aware of the links between the two conditions when assessing the risk of a cardiovascular event in a particular individual.