Erectile Dysfunction Closely Tied to Heart Attack Risk
There’s a strong connection between coronary artery disease (CAD) and erectile dysfunction (ED) that men should not ignore.
“Coronary artery disease (CAD) is one reason some men can’t achieve an erection,” says Cleveland Clinic cardiologist Michael Rocco, MD. “In men ages 40 to 70 who have no symptoms of heart trouble, ED is an independent risk factor for a heart attack within about three to five years.”
The Common Link
The link between ED and CAD is found in endothelial dysfunction, a precursor to atherosclerosis.
In endothelial dysfunction, cigarette smoke, high blood pressure, high cholesterol or another cardiovascular risk factor disrupts the smooth endothelial lining in blood vessels. This allows fatty substances to enter the vessel walls and form plaques. As they grow, plaques narrow the inside diameter of an artery, slowing blood flow.
The reason why ED often occurs before CAD is diagnosed is artery size.
“Penile arteries are 1 to 2 millimeters (mm) in diameter, while coronary arteries are 3 to 4 mm. Therefore, endothelial dysfunction and atherosclerosis may be present earlier in the penis,” says Dr. Rocco.
The slow growth of plaques may also explain why the symptoms of both ED and CAD appear gradually and worsen over time.
Lowering Your Risk
If you experience ED, it’s important to tell your doctor. He or she will want to rule out an underlying disease or medication that might be causing the problem beforechecking your cardiovascular risk.
“Identifying and treating any risk factors you have will help prevent future cardiovascular events and may modestly improve ED,” says Dr. Rocco.
To treat your ED, your doctor may prescribe a phosphodiesterase-5 (PDE5) inhibitor, such as sildenafil (Viagra™), vardenafil (Levitra™), tadalafil (Cialis™) or avanafil (Stendra™). These drugs are safe for the heart. “We have not seen an increase in cardiovascular events in patients with heart disease who take these drugs,” says Dr. Rocco.
Impact of Heart Drugs Varies
You can be assured that medications for heart disease do not cause ED. However, beta-blockers and thiazide diuretics may worsen it. The jury’s still out.
On the other hand, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and calcium channel blockers have been shown to be neutral or potentially beneficial. “ACE inhibitors may help by improving endothelial function. Similarly, statins may benefit ED through their antioxidant and anti-inflammatory properties. In addition, being on statins makes ED drugs work better,” he says.
The Take-Home Message
If you experience ED, speak up, since it can be an early clue to underlying vascular disease. “It’s an opportunity to identify your risk factors and start treating them early to prevent cardiovascular disease, while getting help for your ED,” says Dr. Rocco.