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Erectile Dysfunction Can be a Sign of Coronary Heart Disease

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all areas of Penn Medicine.

Approximately one in five men aged 40 and older experience moderate to severe erectile dysfunction (ED). Now, a study published Jan. 29 in the journal PLOS Medicine suggests that the problem may go hand-in-hand with an array of heart problems, particularly coronary heart disease.  The Australian study followed 95,000 men ages 40 and older for two to three years. During the study period, more than 7,800 of the participants were admitted to the hospital and 2,304 died.

The study, which accounted for other heart disease risk factors, including smoking, physical activity, and others, found that men with ED were 60 percent more likely than those without erection problems to need treatment for heart disease, and they had double the chance of dying during the study.  

Urologist Joseph F. Harryhill, MD, FACS specializes in these sexual issues when treating his patients. Below, Harryhill discusses if this study changes how he treats ED patients, the connection between ED and heart disease, and treatment options.

Q:  This is not the first time ED has been linked to heart problems, but this study builds on that to suggest that even mild ED can be an early warning sign of a heart problem. Does this study change your recommendations or advice to ED patients? 

A: No, this is not the first time erectile dysfunction has been linked to heart problems, and the association dates back at least 10 years in clinical and epidemiologic surveys. 

We know that not only can mild erectile dysfunction be a sign of a potential heart problem (coronary artery disease), but that the symptoms of ED in many cases tend to manifest BEFORE other signs of cardiovascular disease.

Q: Although the study does not say that ED necessarily causes heart problems, it does show a connection between both medical concerns. How can you explain this connection?

A: Both ED and CAD are vascular (specifically arterial) disorders that share a common pathogenesis. Anatomically speaking, the diameter of the coronary vessels and penile arteries are very similar. It is the smaller vessels that are affected first in atherosclerotic disease, in most cases, particularly with the vasculopathy found in diabetes mellitus.

Again, to highlight this association, there is general consensus that onset of sexual dysfunction occurs before symptomatic coronary artery disease in greater than 90 percent of men who have small vessel atherosclerosis. One study showed a mean time interval of 24 months between onset of ED and later development of symptomatic coronary disease.

Q: Erectile Dysfunction, or ED, is one of those medical conditions widely known but rarely talked about openly.  What’s the best way to encourage men facing ED to talk about this with their doctor?

A: It is true that there is often reluctance at times, both on the part of the patient and the physician, to discuss erectile dysfunction. The patient may be embarrassed to bring it up, and fear that treatment may not be effective for them.

This was much more true in the past than at the present time, and with improved public awareness of erectile dysfunction, there is more of an opportunity - and willingness - for open dialogue between the patient and his healthcare provider.

If the provider senses that there is reluctance on the part of the patient, it never hurts to bring up the topic.

Q: Most causes of erectile dysfunction are treatable. Please briefly mention some treatments here at Penn, (oral medications, self injections, implants, etc.)

A: You are correct that most patients with erectile dysfunction can be helped with effective therapy. However, oral medications are only effective in 60 to 70 percent of men. Injection therapy is often a choice to consider if oral medications do not work. Male hormone deficiency can contribute to the problem, and low testosterone can be diagnosed with laboratory tests.

For some men, vacuum erection devices are effective, and at Penn there is always the option of surgical intervention...typically, implantation of a penile prosthesis.

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