Advances & Insights: Hearth Health
September 15, 2007
What the news means for you
Thomas F. Whayne Jr., MD, PhD, FACC Cardiologist
ED should prompt cardiac exam
Recent studies are very interesting and have the potential to lead to earlier diagnosis of cardiovascular disease. The results show there is a correlation between erectile dysfunction and cardiovascular disease, including ischemic heart disease, cerebrovascular disease and peripheral vascular disease.
It is important to note that erectile dysfunction does not cause cardiovascular disease, but it does appear to indicate, when the cause is not emotional or hormonal, that the process of arterial damage is well under way.
Tests to determine cardiovascular risk
Although there is not a consensus on what additional cardiac tests a man with ED should undergo, there are several options. If the only symptom a patient had was ED, then I would probably recommend the LDL cholesterol test. This test is still the gold standard for management. The standard measurements of risk, including smoking, excess weight, LDL and HDL cholesterol, blood pressure, and diabetes, are most often the best things to consider.
Other tests to consider in certain situations include high sensitivity C-reactive protein. This test measures a protein that signals inflammation in the body. A high level is associated with an increased risk for cardiovascular problems. This test has value in patients who may have one or two indicators of heart disease, such as a strong family history, but are otherwise healthy. If a high sensitivity C-reactive protein is elevated then that combined with the family history may lead me to put a patient on a statin.
A coronary artery calcium test may also be considered. This test measures the calcium deposits in the arteries and can indicate if there is plaque in the arteries. If a patient with ED scored significantly above zero on this test it could tell us that the ED is more than likely vascular and that the patient already has some plaques in a key location -- the coronary arteries.
Cholesterol plays a major role in a person’s heart health, making it very important for patients to know their cholesterol level. Patients should also be aware of their blood pressure and know what numbers are normal. I recommend people see their doctors regularly (at least once a year) to get their blood pressure and cholesterol taken. The following numbers indicate the ranges of blood pressure and cholesterol.
- Normal: 120/80 or less (note: this applies across all age ranges)
- Pre-hypertension: 120 - 140/80-90
- Stage 1 hypertension: 140-160/90-100
- Stage 2 hypertension: 160+/100+
- Ideal: Below 150 mg/dL (associated LDL 100mg/L or less)
- Desirable level that puts you at lower risk for heart disease: Less than 200 mg/dL
- Borderline high: 200 to 239 mg/dL
- High: 240 mg/dL and above (increases coronary heart disease risk to more then double that of someone whose level is below 200 mg/dL)
There are some exceptions to these numbers. In a patient where ED was vascular related and there was evidence of arterial cardiovascular disease, obstructions, plaques, arterial sclerosis or diabetes, we would want the LDL to be less than 70 mg/dL.
“Erectile dysfunction does not cause cardiovascular disease, but it does appear to indicate . . .the process of arterial damage is well under way.”
It is important to put tests in context and use them correctly. There is no point in getting another test if it isn’t going to change what I am going to do. If a patient has a high LDL, a low HDL and the blood pressure is high, I don’t need another test to tell me the patient is at risk and I need to treat him or her aggressively.
However, disease sometimes develops without these risk factors and that is when calcium tests, high sensitivity C-reactive protein tests and other tests can be very helpful. Still there is no reason to get them on everyone.
Early warning signs of cardiovascular disease
ED may be a sign of early vascular disease even in a patient who is otherwise asymptomatic. It could be the presenting symptom that leads the physician to test for cardiovascular problems. Symptoms of vascular disease are often varied and can be present with no symptoms. Symptoms may include leg pain, angina (classically presenting as heavy chest pain but may show up as pain in the arm or even teeth) or fatigue.
Erectile dysfunction is proving to be an important warning of possible vascular disease. ED should prompt investigation and intervention for cardiovascular risk factors. It could help us catch the presence of atherosclerosis (hardening of the arteries) that has developed over years. If you are experiencing prolonged ED, talk to your doctor.
Dr. Whayne is a cardiologist at the UK Gill Heart Institute and a professor of medicine at the UK College of Medicine, with a special interest in cardiovascular risk reduction and lipid management.
Erectile dysfunction may be sign of cardiovascular disease
Cardiovascular disease is the leading cause of death in the United States, accounting for almost 40 percent of all deaths. Several risk factors associated with cardiovascular disease are also associated with erectile dysfunction (ED), including obesity, tobacco use, physical inactivity, diabetes, hypertension and hyperlipidemia.
“Several risk factors associated with cardiovascular disease are also associated with erectile dysfunction (ED).”
Studies are now suggesting that ED may be an early warning sign of cardiovascular disease and other vascular diseases. This knowledge could help the more than 10 million men in the United States affected by severe ED detect cardiovascular disease early and initiate cardioprotective interventions before a heart attack.
Erectile function linked with heart health
Vascular disease and erectile dysfunction share common causes and the functional changes associated with both diseases are similar. Vascular diseases affect the blood vessels. One of the most common vascular diseases is cardiovascular disease, or disease of the arteries leading to the heart.
Vascular disease causes hardening of arteries (atherosclerosis) throughout the body and can restrict blood flow to organs. It is noticed in the form of a heart attack when the larger arteries leading to the heart have plaque buildup or narrowing.
However, research now shows the damage often shows up first in the small penile arteries and is manifested in the form of erectile dysfunction. The penis contains two cylindrical, sponge-like structures that run along the length of the penis. Nerve impulses cause the blood flow to increase to about seven times the normal amount when a man is sexually aroused. Vascular disease can restrict the blood supply to the penis, causing ED.
Studies estimate vascular diseases may be responsible for causing ED in as many as 50 to 70 percent of men who develop the condition. And signs of ED may occur up to three years before cardiovascular disease is noticed.
All men experience erectile dysfunction on occasion and this is normal. However, if erectile dysfunction lasts longer than two months or is a continually recurring problem it is important to see a doctor to determine the underlying cause or causes.
“Vascular disease can restrict the blood supply to the penis, causing ED.”
Other causes of erectile dysfunction
It is important to note that erectile dysfunction is not always a sign of poor heart health. It can be caused by emotional problems, such as stress or depression, and in a small number of men ED can be hormonal. Certain medicines, alcohol and smoking can also contribute to erectile dysfunction.
Risk factors of vascular disease
Many factors increase the risk of developing vascular disease, which may lead to ED. Smoking, being overweight, an unhealthy diet, lack of exercise, diabetes, hypertension (high blood pressure), high cholesterol levels, stress, family history of vascular disease, angina, heart attacks and stroke are all risk factors for peripheral vascular disease. Additionally, vascular disease affects men more frequently than women.
For more information, see:
- Erectile dysfunction as a risk factor for coronary heart disease: Implications for prevention , Medscape, March 6, 2007 (Subscription required)
- WSJ.com Forums: A surprising risk factor for heart disease in men.Wall Street Journal , February 20, 2007 (full article only available to subscribers)
- Erectile dysfunction and subsequent cardiovascular disease,JAMA , December 21, 2005
- Erectile dysfunction/Impotence , Health Information, UK HealthCare
- Vascular conditions and diseases , Health Information, UK HealthCare
UK HealthCare cardiac resources - UK Gill Heart Institute
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