You May Have Heart Disease

Few men feel comfortable discussing their sexual health, even with their doctors. But erectile dysfunction (ED), the inability to attain or maintain an erection sufficient for intercourse, can be a warning sign of blood vessel diseases, as well as heart disease and male hormone problems. Three factors that can impact the ability to achieve an erection are: the brain and nervous system; hormones, such as testosterone; and blood vessels.

“If you do not have heart disease, but have had erectile dysfunction or impotence for three years, this could be an early indication that you should have blood tests to assess C-reactive protein, homocysteine and ADMA levels, as well as a lipid profile, male hormone panel and X-rays to evaluate blood vessel disease,” says George Yu, MD, Urologist and Clinical Professor of Urology at The George Washington University Hospital.
 
Understanding the connection
 
Heart disease and ED can be linked through problems with blood vessels or with medications. Here are two examples:

Blood vessel malfunction: An erection occurs when the blood vessels supplying the penis release a chemical called nitric oxide that causes the vessel walls to relax, allowing an increase in blood flow to the penis. In people with cardiovascular disease, the vessel walls don’t respond normally to nitric oxide, thereby preventing or reducing the increase in blood flow. Also, just like the arteries around the heart, the blood vessels in the penis can be blocked by cholesterol plaque buildup.

“The heart and the genitalia are part of the same vascular system — anything that affects some of the blood vessels can affect them all,” says Joel Rosenberg, MD, Director of Clinical Cardiology and Clinical Professor of Medicine in Cardiology. He notes that ED is strongly correlated with other heart disease risk factors, including diabetes, obesity and high blood pressure.

Medications: Certain medications, such as beta blockers and diuretics, which are used to treat high blood pressure, and antidepressants can produce ED. If your medications are associated with sexual side effects, your doctor may be able to adjust your dose or prescribe an alternative.

It is also important to know that medications that are used to treat ED (such as Cialis, Levitra and Viagra) usually can be taken safely by people who have heart disease. However, while taking such medications, certain other drugs should be avoided completely, such as nitroglycerin or other nitrate preparations, or used carefully, such as alpha blockers, which are commonly taken to treat problems of the prostate. The combination of such medications can produce a dangerous drop in blood pressure.
 
An early warning
 
By serving as an early warning sign of heart disease, ED alerts you to take steps to protect your heart — and your sexual function. In recent studies, ED was found to be an even stronger predictor of heart disease than traditional risk factors, such as family history, cholesterol levels or blood pressure. Another study indicated that men with both “silent” heart disease (meaning they had no symptoms) and type 2 diabetes were nine times as likely to have ED as diabetic men without heart disease. Studies show that 30 to 40 percent of men with ED also will have heart disease. And on the flip side, men with known cardiovascular disease have a 60 to 80 percent association with ED.

Remember, ED does not always indicate cardiovascular issues. “ED can certainly be a normal part of the aging process,” says Paul Shin, MD, urologist and Clinical Assistant Professor of Urology. “Other factors, including hormonal changes, such as a decreasing testosterone, may indirectly affect the quality of a man’s erection through decreased energy level and libido.”

“It’s important to realize that erectile function is a barometer of a man’s overall well-being,” says Thomas Jarrett, MD, Chairman and Professor of Urology at GW Hospital. “Therefore, if you’re experiencing sexual problems, do not ignore them — get help.”

If you are experiencing even occasional erectile dysfunction, make an appointment with a physician to evaluate your treatment options and determine if it may be linked to your heart health. Please call
1-888-4GW-DOCS or visit www.gwhospital.com.

---

As seen in The George Washington University Hospital Health News Spring 2007.