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Q
Erectile Dysfunction Epidemic?
Does heart disease lead to erectile dysfunction (ED) or the other way around? How are the two related?
A
Answer (Published 1/18/2008)

In recent years, a growing body of evidence has linked erectile dysfunction (ED, once called impotence) to heart disease. The inability to achieve or sustain an erection is a condition affecting more than 18 million American men, according to results of a study from Johns Hopkins published in the Feb. 1, 2007 issue of the American Journal of Medicine. The researchers found that almost 50 percent of the men in the study with diabetes (a risk factor for heart disease) also had erectile dysfunction and almost 90 percent of the men with ED had at least one risk factor for cardiovascular disease, including diabetes, high blood pressure, smoking or high cholesterol levels. What's more, the men with ED were less physically active than the men in the study who reported no problems with their erections.

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A University of Chicago study published in 2006 found that erectile dysfunction was a stronger risk for heart disease than high blood pressure and high cholesterol. The men in this study had been referred for stress testing because of suspected heart disease, but the Chicago researchers said that even among men without heart symptoms, ED is a strong risk factor for a future heart attack.

Cardiovascular disease and most cases of ED are similar in that both can stem from damage to blood vessels (less often, ED is psychological or emotional in nature or due to nerve damage). Just as high blood pressure and high cholesterol can injure arteries that supply blood to the heart, they can injure the arteries that supply blood to the penis. Diabetes can damage both blood vessels and the nerves involved in erections. Smoking, poor diet and lack of exercise can also contribute to ED, just as they do to heart disease. In some cases, however, the problem may be a side effect of prescription medications (antidepressants or some medications for high blood pressure for example). Low levels of testosterone can also play a role, but in general it is safe to assume that what's bad for the heart is also bad for a man's sexual health.

Don't assume that ED is an inevitable part of aging. It isn't. You should also be aware that not all physicians are up to speed on the newfound link between ED and cardiovascular disease. If you have ED, ask your doctor to check you for heart disease before prescribing a pill for ED.

Andrew Weil, M.D.

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