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Erectile dysfunction: A symptom of heart disease?

April 17, 2018 | UCI Health
man with erectile dysfunction with wife on sofa

Is there a connection between erectile dysfunction and heart disease?

Yes, says Dr. Faysal Yafi, director of the Men’s Health Services at the UCI Health Center for Urological Care.

“There has been consistent data that ED [erectile dysfunction] might be the first sign of cardiovascular disease in younger men,” says Yafi.  “When men in their 30s and 40s come in with ED, I will often recommend a referral to a cardiologist.”

ED risk factors

About 30 million American men, or one in three, will experience ED in their lifetime. It’s an important quality of life issue for men and their partners.

Doctors are seeing more of it than in the past, primarily because men are living longer and the lifestyles of younger men aren’t as healthy as in the past, Yafi says.

Risk factors include:

Causes of erectile dysfunction

An erection happens when blood rushes to the penis. But when arteries are clogged by atherosclerosis, the reduced blood flow results in impotence.

Plaque — deposits of calcium, fat, cholesterol, cellular waste and the blood-clotting chemical fibrin — narrow the arteries leading to the heart and brain, reducing the flow of oxygen-rich blood and increasing the risk of heart attack and stroke.

Because the arteries of the penis are so small to begin with, it takes a lot less disruption in blood flow to affect them. That’s why problems tend to show up as erectile dysfunction before other symptoms of cardiovascular disease appear.

Fixing low testosterone

“ED is also often associated with decreased testosterone levels,” Yafi says. “Data suggest that men who have low testosterone levels, if uncorrected, may be at higher risk for cardiovascular disease and stroke.”

There are many other causes of ED, such as:

Yafi also screens for factors that include family and psychological history, smoking, hypertension and other physical conditions, problems with exercise as well as hormone levels.

“Any man who has ED should see their primary care doctor or urologist,” Yafi says. “A thorough work-up should be performed because it could be an indication of cardiovascular disease."

Safe solutions for ED

“Plus, we can help,” he says. “For every man, one way or another, we can ensure they can have an erection.”

Pills for ED, such as Viagra or Cialis, are often the first treatment attempted. Yafi says the medications work well for a majority of men. Although men taking nitroglycerin for angina should not take them, Yafi says the drugs are very safe and actually may protect the heart.

For those who don’t respond to pills, other treatment options — such as injections, vacuum erection devices and surgical interventions — may be offered with excellent results.

“Viagra was discovered in the ’90s when researchers were looking for pulmonary medications,” Yafi says. “A lot of data show they are protective for the heart.”

A more comfortable conversation

Often men with ED arrive at doctor’s appointments that have been made for them by their lovers. But the denial and stigma attached to ED have largely disappeared as commercialization of medications for the condition has made it a more comfortable conversation.

In fact, men who might otherwise ignore potentially serious symptoms such as chest pains are more likely to come to the clinic if they have trouble getting an erection or urinating.

“The urologist is almost seen as a gateway for men to other doctors,” Yafi says. “When it comes to ED and quality of life, men will see a urologist.”

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