Erectile Dysfunction: A Harbinger of Heart Trouble
FRIDAY, Oct. 5 -- Few men may realize it, but if they're having problems achieving or sustaining erections, it may signal underlying heart trouble.
Erectile dysfunction, or impotence, affects more than 18 million American men, according to a recent study by researchers at the Johns Hopkins Bloomberg School of Public Health.
And now a growing body of research ties erectile dysfunction to vascular diseases, such as coronary artery disease.
"Erectile dysfunction is often caused by vascular disease," explained Dr. Ian Thompson, professor and chairman of the department of urology at the University of Texas Health Science Center at San Antonio. "A man could perceive decreased blood flow to the penis as being a less strong, a weaker erection, and that may actually be one of the first indicators of blood vessel disease."
One recent report found men with erectile dysfunction had poorer scores on exercise tests and other measures of coronary heart disease. They also had evidence of significant coronary artery blockages.
"Our study found that among men who were sent for a stress test by their doctor, the presence of erectile dysfunction was a potent predictor -- a strong risk factor -- for significant underlying heart disease," said lead researcher Dr. R. Parker Ward, an assistant professor of medicine and director of the cardiology clinic at the University of Chicago Hospitals.
"It was a stronger risk factor than some of the traditional risk factors we commonly ask questions about, things like high blood pressure and high cholesterol," he added.
Ward's study, published last year in the Archives of Internal Medicine, involved men who had been referred to cardiologists for nuclear stress testing, a noninvasive way to determine the severity of coronary heart disease. But even among men without heart symptoms, erectile dysfunction is a strong risk factor for future risk of heart attack, he noted.
In the same issue of the journal, Dr. Steven A. Grover and colleagues studied a group of 3,912 Canadian men, nearly half of whom reported having erectile dysfunction in the four weeks prior to visiting their family physicians. The men's cholesterol, glucose and blood pressure measurements were taken.
"When you calculated a global cardiovascular risk, [it] was strongly associated with the probability that you had erectile dysfunction," said Grover, a professor of medicine and epidemiology at McGill University Health Centre in Montreal. "And subsequently there have been other studies that have shown that people who have erectile dysfunction are, in fact, more likely to develop cardiovascular disease in the future."
Thompson and his colleagues provided the first substantial evidence linking erectile dysfunction and subsequent risk for heart disease in a December 2005 report in the Journal of the American Medical Association. Yet the connection is not as well recognized among doctors and patients as cardiologists and urologists think it should be.
"A lot of men don't have physicians," Thompson explained. "They may not know what their blood pressure is or their lipid profiles, or they may be smokers, and they may never have been counseled to stop smoking or to reduce their weight.
"We think that if men with erectile dysfunction went to see their physicians, it may enable the interaction with the physician to discuss other coronary risk factors," he said.
Erectile problems aren't always vascular in nature. Sometimes the trouble is psychological or neurological and wouldn't necessarily be associated with a higher risk of heart disease, Ward cautioned. Still, research linking erectile dysfunction (ED) and heart disease suggests that a proactive approach is the best medicine.
"We as physicians should be asking about, and men should be reporting to their physicians, symptoms of ED, so it can be considered as we work to modify their risk -- treat blood pressure, cholesterol more aggressively, advise healthy lifestyle changes like exercise and healthy diet," he said.
Visit the U.S. National Heart, Lung, and Blood Institute for more on coronary artery disease.
Posted: October 2007
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