Health & Fitness

ED: A warning sign for heart issues

Erectile dysfunction isn’t just a sexual problem — it can be a warning sign of cardiovascular disease.

“One of the things we have found is men with erectile dysfunction, particularly the younger age group, have a higher risk of having silent heart disease and they’re predisposed in the future to developing heart attacks and strokes,” said Dr. Bruce Kava, associate professor of urology at University of Miami Miller School of Medicine and chief of urology at Miami Veterans Affairs Medical Center.

“As a result of this, many of us have changed the way we approach our young men with erectile dysfunction. We want to have them evaluated for clinically silent heart disease that may be present.”

A Johns Hopkins study of 1,862 men over nine years found a strong connection between cardiovascular issues and erectile dysfunction. Study participants who presented atherosclerosis as well as arterial stiffness and dysfunction were 53 percent more likely to self-report erectile dysfunction in the latter part of the study’s duration. The study, “The Association of Subclinical Vascular Disease and Erectile Dysfunction at 9-Year Assessment: The Multi-Ethnic Study of Atherosclerosis,” was presented at the 2014 American Heart Association’s Scientific Sessions.

Another study, this one published in 2012 and featured in The Journal of Sexual Medicine, found that men between 30 and 40 years old and who have severe periodontal disease were three times more likely to have erectile dysfunction.

South Florida doctors warned that patients shouldn’t jump to conclusions based on the latter study.

“I don’t think that anybody believes that if you get gum disease, you’re going to get erectile dysfunction,” said Dr. David Genet, a periodontist with a private practice in Aventura. “But, however, a chronic inflammatory disease on any part of your body does have an impact on the rest of your body.”

This study, conducted by Turkish researchers, looked at 80 men with erectile dysfunction and also at a control group of men. Researchers then examined the degree, if any, of gum disease the men had.

Kava said the study has some flaws, including that it looked at men in their 30s. If a man in his 30s has erectile dysfunction, it’s more likely connected to psychological instead of vascular problems, he said.

In vascular disease, fat and cholesterol build up in the blood vessels. As this plaque builds up, the arteries narrow and blood flow is restricted. The condition is known as atherosclerosis and it can occur in the penis as well as in blood vessels in other parts of the body.

“So the simple way of looking at this is the vessels to the penis tend to be a lot smaller than to the heart, so the disease tends to manifest itself a lot faster in the penis than in the heart,” said Dr. Jorge Caso, a urologist at the Columbia University Division of Urology at Mount Sinai Medical Center in Miami Beach. “It’s a more complicated picture than that, but erectile dysfunction is sort of the harbinger of what could come in the future. … The point is you’re getting atherosclerosis disease in the penis but it’s not only in the penis. The penis is less robust so it might show symptoms before the heart does.”

Erectile dysfunction might also indicate there is vascular disease in other parts of the body aside from the heart, but doctors tend to focus on the cardiovascular risk.

“The conclusion is that erectile dysfunction is a harbinger of cardiovascular disease,” said Dr. Bernard Ashby, cardiologist, Columbia University Division of Cardiology at Mount Sinai Medical Center in Miami Beach. “Just having erectile dysfunction, the risk of cardiovascular disease is exponentially higher.”

According to the American Heart Association, erectile dysfunction may be a sign that a heart attack may occur in three to five years. That gives doctors and patients time to target the risk factors and embark on preventative care, which usually means losing weight, exercising more and stopping smoking.

Urologists first determine whether a patient’s erectile dysfunction is caused by a vascular problem by getting an ultrasound of the penis. Psychological problems such as depression might also cause erectile dysfunction. If vascular issues are found, then doctors investigate further.

Among the risk factors doctors check are high blood pressure, diabetes and heart problems. Doctors might do an electrocardiogram (EKG) that checks the electrical activity in the heart. Also, doctors check whether the patient smokes and whether he is overweight or obese.

According to Cleveland Clinic, high blood pressure, high cholesterol and atherosclerosis account for 70 percent of erectile dysfunction cases that have a physical instead of a psychological cause. As many as half of the men diagnosed with diabetes have erectile dysfunction, said Cleveland Clinic.

“We don’t need a randomized controlled trial to know a parachute works,” Caso said. “If you’re young and you have a lot of cardiac risk factors and modify that, you’re probably going to live to be older.”