ED As a Warning Sign?

Summarized by Robert W. Griffith, MD
January 16, 2006

Introduction

Over 10 million men in the USA suffer from erectile dysfunction, or ED, and probably over 100 million men are affected worldwide. The risk factors for ED include increasing age, smoking, diabetes, heart disease, and high blood pressure. But how about ED being a risk factor for something else?

The clue, obviously, comes from the way in which ED comes about: most of the risk factors for ED have a feature in common - the presence of atherosclerosis ¹ in the small penile arteries, which leads to partial obstruction and thereby failure to allow an adequate erection. As the penile arteries may show such changes earlier than the larger coronary arteries, ED may indeed be a warning sign of further arterial disease to come.

A study has now been reported that supports the notion that ED is a predictor of heart disease. It's published in the Journal of the American Medical Association, and is summarized here.

What was done

Volunteers enrolled in the Prostate Cancer Prevention Trial, which was conducted at 221 centers throughout the United States, provided the information used in this analysis. This trial was designed to compare a drug (Proscar ®, or finasteride) with placebo in preventing the occurrence of prostate cancer. The subjects taking the placebo formed the participants in this investigation. They were all over 55 years old at enrollment, which started in 1994, and they were evaluated for ED and cardiovascular disease every 3 months until 2003.

Specific questions about sexual function included a grading of any erectile dysfunction, any decrease in libido, and any decrease in volume of ejaculate.

Cardiovascular disease was defined as any of the following: heart attack (myocardial infarct or MI), coronary artery bypass surgery or angioplasty, angina, stroke (including transient ischemic attack), congestive heart failure, an abnormal heart rhythm needing treatment, or cardiac arrest.

Included in the analysis were the following factors: age, body mass index (BMI), blood pressure, blood lipid levels, diabetes, family history of MI, smoking history, race, physical activity, and quality-of-life assessment.

What the analysis showed

Almost 9,500 men were enrolled; 15% of them had some evidence of cardiovascular disease at entry, and were excluded from further analysis, leaving over 8,000 men in the analysis. Their average age was 62, their BMI 27.5 (i.e. overweight), blood pressure 138/82 mmHg, total cholesterol 212 mg/dL, and 92% were white. About 8% were current smokers, 21% were on antihypertensive medication, and 47% reported some degree of ED at entry.

Of the men without baseline ED, over half (57%) had developed it after 5 years, and 65% after 7 years. These men had a 25% increased risk of a cardiovascular event compared with men who never had the problem. For those who had ED before the study started or who developed it during the study, the risk of a cardiovascular event was 45% greater than for those men without ED. The events for which the risks were particularly higher were angina, heart attack, transient ischemic attack, and stroke.

Further analyses showed that the links between ED and subsequent cardiovascular problems persisted even when adjusted for possible effects of smoking, cholesterol level, family history of MI, and the other factors studied.

What these findings mean

First, the overall frequency of ED may seem high, but it is, in fact, in line with that reported previously in other studies. Second, the increased frequency of cardiovascular disorders in those men who had or developed ED was similar to the risk associated with current smoking, a family history of MI, or raised blood lipid; in other words - it's considerable.

One year after the first report of ED 2% of the men in the study had experienced a 'cardiovascular event'; by five years, 11% of the men had had such an occurrence.

It seems clear that ED should be added to the other risk factors for cardiovascular disease - smoking, high blood pressure, overweight, family history of MI, high cholesterol, diabetes, and so on. What's important, however, is the fact that ED preceded the other, more usually recognized, risk factors. This means that men who are otherwise healthy who develop ED should not be shy about visiting their physicians; there may be more at stake than occasional sexual dissatisfaction. And wives or partners of affected men should encourage them to go to their doctor for a check-up; as we've said already, it's not all just about sex.

Source

• Erectile dysfunction and subsequent cardiovascular disease. TIM. Thompson , TCM. Tangen , GPJ. Goodman ,  al., , 2005, vol. JAMA , pp. 2996--3002

Footnotes
1. Atherosclerosis is the process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This buildup is called plaque. Plaques can grow large enough to significantly reduce the blood flow through an artery.

Related Links
Exercise to Fight Erectile Dysfunction
Smoking and Erectile Dysfunction
Premature Ejaculation - A Fact Sheet

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