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Erectile Dysfunction Can be a Sign of Coronary Heart Disease

Tocelebrate February as American Heart Month, the News Blog is highlighting someof the latest heart-centric news and stories from all areas of Penn Medicine.

Approximately one in fivemen aged 40 and older experience moderate to severe erectile dysfunction (ED). Now, a study published Jan.29 in the journal PLOS Medicinesuggests that the problem may go hand-in-hand with an array of heart problems, particularly coronary heart disease.  The Australian study followed 95,000 men ages40 and older for two to three years. During the study period, more than 7,800of the participants were admitted to the hospital and 2,304 died.

The study, which accountedfor other heart disease risk factors, including smoking, physical activity, andothers, found that men with ED were 60 percent more likely than those withouterection problems to need treatment for heart disease, and they had double thechance of dying during the study.  

Urologist Joseph F. Harryhill, MD, FACS specializes in these sexual issueswhen treating his patients. Below, Harryhill discusses if this study changeshow he treats ED patients, the connection between ED and heart disease, andtreatment options.

Q:  This is not thefirst time ED has been linked to heart problems, but this study builds on thatto suggest that even mild ED can be an early warning sign of a heart problem.Does this study change your recommendations or advice to ED patients? 

A: No, this is notthe first time erectile dysfunction has been linked to heart problems, and theassociation dates back at least 10 years in clinical and epidemiologicsurveys. 

We know that not only can mild erectiledysfunction be a sign of a potential heart problem (coronary artery disease),but that the symptoms of ED in many cases tend to manifest BEFORE other signsof cardiovascular disease.

Q: Although the study does not say that ED necessarilycauses heart problems, it does show a connection between both medical concerns.How can you explain this connection?

A: Both ED and CADare vascular (specifically arterial) disorders that share a commonpathogenesis. Anatomically speaking, the diameter of the coronary vessels andpenile arteries are very similar. It is the smaller vessels that are affectedfirst in atherosclerotic disease, in most cases, particularly with thevasculopathy found in diabetes mellitus.

Again,to highlight this association, there is general consensus that onset of sexualdysfunction occurs before symptomatic coronary artery disease in greater than90 percent of men who have small vessel atherosclerosis. One study showed amean time interval of 24 months between onset of ED and later development ofsymptomatic coronary disease.

Q: Erectile Dysfunction, or ED, is one of those medicalconditions widely known but rarely talked about openly.  What’s the best way to encourage men facingED to talk about this with their doctor?

A: It is true thatthere is often reluctance at times, both on the part of the patient and thephysician, to discuss erectile dysfunction. The patient may be embarrassed tobring it up, and fear that treatment may not be effective for them.

Thiswas much more true in the past than at the present time, and with improvedpublic awareness of erectile dysfunction, there is more of an opportunity - andwillingness - for open dialogue between the patient and his healthcareprovider.

Ifthe provider senses that there is reluctance on the part of the patient, itnever hurts to bring up the topic.

Q: Most causes of erectile dysfunction are treatable.Please briefly mention some treatments here at Penn, (oral medications, selfinjections, implants, etc.)

A: You are correctthat most patients with erectile dysfunction can be helped with effectivetherapy. However, oral medications are only effective in 60 to 70 percent ofmen. Injection therapy is often a choice to consider if oral medications do notwork. Male hormone deficiency can contribute to the problem, and lowtestosterone can be diagnosed with laboratory tests.

Forsome men, vacuum erection devices are effective, and at Penn there is alwaysthe option of surgical intervention...typically, implantation of a penileprosthesis.

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