Erectile Dysfunction Can Be a Sign of Heart Disease

Worried couple sitting in bed
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Having an erection is natural, so when that ability is lost, it’s a sign that something has gone wrong.

Men may find it difficult or impossible to achieve an erection when the nerves have been damaged by a radical prostatectomy or spinal cord injury. Performance anxiety can trigger erectile dysfunction in a young man.

But when a man in his 40s or older gradually begins having difficulty achieving an erection, the underlying cause is nearly always cardiovascular disease or diabetes mellitus.

Few men consider erectile dysfunction good news. However, in these cases, making certain lifestyle changes can lower the risk of heart attack and stroke and may restore potency, as well. The sooner these modifications are made, the higher the chance normal sexual function can be restored.

First Signs of Trouble

When a man does not get regular checkups, erectile dysfunction may be the first indication he has cardiovascular disease or diabetes.

In both diseases, fatty plaques build up in the arteries, interfering with blood flow. Plaques that slow blood flow to the heart can cause a heart attack. When the brain or neck arteries are affected, a stroke can occur. When the arteries of the penis become narrowed, erectile dysfunction happens.

As soon as a man begins experiencing erectile dysfunction, he should see a primary care physician.

The doctor will perform a cardiovascular workup to assess factors that increase the risk of cardiovascular disease—blood pressure, blood lipids, blood sugar, weight and smoking status.

Depending on the findings, medications and lifestyle changes may be needed to lower the risk of heart attack and stroke. While lifestyle changes alone may not be sufficient to restore potency, they are likely to increase the chance that first-line medications for erectile dysfunction will work.

Starting Treatment

The first treatment for erectile dysfunction usually is one of the phosphodiesterase type 5 (PDE5) inhibitors: sildenafil (sold under the brand name Viagra), tadalafil (sold under the brand name Cialis) or vardenafil (sold under the brand name Levitra).

Two-thirds to three-fourths of men will be able to achieve an erection with these drugs.

The medication will not work if blood flow to the penis is poor or the nerves required for an erection have been damaged. The drugs also may not work in men with advanced cardiovascular disease, which is why it’s important to take cardiovascular risk seriously at the first sign of erectile dysfunction.

Improving and Maintaining Potency

If a PDE5 inhibitor doesn’t work right away, making healthy lifestyle changes may pave the way for the medication to kick in.

I once saw a patient with erectile dysfunction, who had borderline high blood pressure and diabetes and was overweight. I prescribed Viagra and advised him to see a doctor about his risk factors. A year later, he returned to tell me that he had started exercising and eating a heart-healthy diet and had lost 50 lbs. He no longer needed blood pressure or diabetes medications… or Viagra. His erectile dysfunction had disappeared.

Take Charge to Reap the Benefits

The incidence of erectile dysfunction increases each decade throughout life, just as the risk of cardiovascular disease and other age-related diseases grows.

It is normal for men who take steps to control their risk factors for cardiovascular disease to maintain sexual function well into their 80s and 90s.

Unfortunately, there’s no easy fix. You can’t adopt one healthy habit—for example, drinking pomegranate juice—while continuing to lead an unhealthy lifestyle and hope that your cardiovascular disease and erectile dysfunction will disappear. If you are motivated to have a healthy sex life, a heart-healthy lifestyle is the answer.

In general, what is good for vascular health is good for preserving potency throughout life. This means not smoking, maintaining a normal weight, getting regular exercise and eating a heart-healthy diet, such as the Mediterranean diet.

Dr. Montague is a urologist in the Center for Genitourinary Reconstruction at Cleveland Clinic’s Glickman Urological and Kidney Institute, the nation’s No. 2 urology program as ranked by U.S. News & World Report.

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