Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for intercourse. We’ve known for more than a decade that ED is a strong risk factor for a future heart attack. New research from Johns Hopkins published in 2018 went far beyond that, showing that ED indicates a greater cardiovascular risk than previously thought, independent of such factors as cholesterol levels, smoking, or high blood pressure.
The Hopkins researchers tracked 1,757 men between the ages of 60 and 78 for more than four years and found that those with ED were more than twice as likely to have heart attacks, strokes or die as a result of these and other heart-related problems than men without the condition.
An estimated 20 percent of all men over age 20 are affected by ED. Although it becomes more common as men get older, ED isn’t considered a natural part of aging. The Hopkins researchers determined that the risk factors for this condition are similar to those that underlie heart disease – obesity, high blood pressure, smoking, diabetes and metabolic syndrome (a constellation of conditions that dramatically increase the risk of diabetes, heart disease, and stroke).
Cardiovascular disease and 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. An even more common cause of ED than arterial problems is penis venous leakage (veins in the penis that leak). Diabetes can damage both blood vessels and nerves involved in erections. Smoking, poor diet and lack of exercise can contribute to ED, just as they do to heart disease. In general, it is safe to assume that what’s bad for the heart is also bad for a man’s sexual health.
The Hopkins study’s senior investigator, Michael Blaha, M.D., M.P.H., a professor of medicine, wrote that the results reveal that ED “is, in and of itself, a potent predictor of cardiovascular risk” and suggested that doctors screen affected men for heart disease regardless of other risk factors. He also advised that men who develop ED seek a comprehensive cardiovascular risk evaluation from a preventive cardiologist and that doctors consider managing risk factors such as high blood pressure or high cholesterol “much more aggressively” in men with ED.
Men should be aware that not all physicians are up to speed on the link between ED and cardiovascular disease. If you are affected, ask your doctor to refer you to a preventive cardiologist who can evaluate your heart disease risk and help you manage it.
Andrew Weil, M.D.
Michael J. Blaha et al, “Erectile Dysfunction as an Independent Predictor of Future Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis.” Circulation, June 11, 2018 doi.org/10.1161/CIRCULATIONAHA.118.033990