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Erection problems may indicate serious heart disease

Erectile dysfunction studies on men with type 2 diabetes have shown that erection problems are a powerful early warning indicator of serious heart disease, including the possibility of heart attack and even death.

And even more important is the finding that cholesterol-lowering medications can reduce the chance of heart problems by about 30%, while Viagra and similar compounds may also be able to offer some protection.

This research can be found in the May 27, 2008, Journal of the American College of Cardiology. It emphasizes how important it is for men to consult their doctors about ED and for their doctors to treat sexual dysfunction as well as overall cardiovascular health.

The development of erectile dysfunction can be used to alert both patients and doctors to future coronary heart disease; other danger signs such as poor blood glucose control, high blood pressure, excessive cholesterol levels, and of course smoking and obesity need to be tacked with force. This is because diabetes, erection problems and heart disease have an ominous factor in common - damage to the blood vessels by high blood sugar levels.

"The first event is probably endothelial related dysfunction - meaning the smoothness and reactivity of the lining of the blood vessel are damaged," said Dr. Tong of the Prince of Wales Hospital, Hong Kong. He went on to explain that this encourages inflammation on the surface of the blood vessels and causes deposition of cholesterol, which in turn forms clots and leads to atherosclerosis. This is a major risk factor for blockage of blood vessels in the heart, and this can cause a heart attack.

Men often show signs of erection problems more than three years before they show symptoms of coronary heart disease: in one study conducted on diabetic men, symptoms of erectile dysfunction always preceded coronary symptoms.

Dr Tong and his assistants were trying to determine whether erection issues were a warning sign of deteriorating cardiovascular health. Studying over 2,300 men with type 2 diabetes, they found initially one-quarter of the study participants had signs of ED.

Over four years, they recorded that 123 of these men had a heart attack, died from heart disease, developed blocked arteries, or needed angioplasty or bypass surgery. Men with erectile dysfunction were more likely to develop a sign of coronary heart disease than men who did not show signs of ED at the start of the study. Analysis revealed that diabetic men with ED stood twice as much chance of a Coronary Heart Disease Event each year as did diabetic men without erection problems.

Analysis of other characteristics associated with the development of CHD, including age, high blood pressure, excessive cholesterol, long term diabetes and kidney damage, showed that erection problems were an independent early sign of coronary heart disease. To be exact, erection problems indicated an almost 60% increase in the chance of a man having coronary heart disease. The only indicator which showed more correlation with heart disease was excess protein in the urine.

In a second investigation, just over 290 men with type 2 diabetes and silent CHD were studied. At the start of the experiment, just under 120 had erectile dysfunction; over the four year period of the investigation, it transpired that men with erectile dysfunction at the star of the study were twice as likely to have a major cardiac problem as men without ED.

Cholesterol-lowering drugs of the statin family reduced the risk of MACE by one third, while more surprisingly, perhaps, Viagra and other 5-phosphodiesterase (5PDE) inhibitors also seemed to reduce the risk of MACE. Robert A. Kloner, professor of medicine at the University of Southern California, observed that although we know erection problems share risk factors with CHD, including hypertension, hyperlipidemia, smoking and diabetes, it's a new finding that ED is a significant risk factor for heart disease in its own right. Thus, the lesson for men is this: to take note of the fact that their erectile dysfunction really is a sign of atherosclerosis.

He also observes that taking statins is not enough - controlling blood pressure and low density lipoprotein levels, and other risk factors is also critical for men with diabetes. In particular, smoking is essential. 

Dr. Tong and his associates are still analyzing over 10,000 patients who show signs of diabetes so that they can better understand the link between erectile dysfunction, heart disease, and diabetes. The essence of this question is this: are patients with erectile dysfunction and diabetes-related eye or kidney problems at greater risk of death or cardiovascular disease - and by how much? No doubt the answers will become clear as the studies proceed.


Risk factors for erection problems

These are the generally accepted risk factors for erectile dysfunction - although these may relate more to erectile dysfunction which is induced by physical problems than psychological problems.

Age

Although men of all ages are susceptible to erection problems, they are more likely as you get older. Between 40 and 70 years of age, the chance of a man being unable to have any erections increases from 5 to 15 percent.

Source: Feldman HA, Goldstein I, Hatzichristou DG, et al.
Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Journal of Urology. 1994; 151: 54-61.

But it isn't simply age that causes erection problems. In many cases, the erection problems are the result of some other condition associated with ageing.

Diabetes

Diabetes stops the body controlling the level of sugar in the blood stream, and is the result of the lack of insulin (type 1) or the insulin not working correctly (type 2 diabetes). Unfortunately, having diabetes means that you are almost twice as likely to have some form of erection problem when compared to men without diabetes.

Source: Johannes CB, Araujo AB, Feldman HA, et al.
Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. Journal of Urology. 2000; 163: 460-463.

High levels of cholesterol

Cholesterol is manufactured in the liver as well as absorbed from food. Its function in the body include acting as a precursor to the sex hormones, and assisting in the manufacture of bile. It is also an important part of cell membranes. So-called "good cholesterol" is HDL or high density lipoprotein; so-called "bad cholesterol" is low density lipprotein or LDL. Excessively high levels of LDL cholesterol means you have a high risk of heart disease and subsequent atherosclerosis. LDL cholesterol ("bad cholesterol"), is also implicated in the onset of erection problems.

Source: Feldman HA, Goldstein I, Hatzichristou DG, et al.
Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Journal of Urology. 1994; 151: 54-61.

Atherosclerosis

Atherosclerosis, a condition which is also known as hardening of the arteries develops when fat deposits (cholesterol in particular) become adherent to the inner walls of the arteries - this leads to damage to the endothelial lining of the blood vessels, causing scarring, narrowing and clogging of these crucial blood vessels.  The difficulty that blood has in flowing through the vessels can cause strokes, heart attacks - and, if it affects the penis - erection problems.

Certain drugs cause erection problems

Having to take prescription medication for heart disease are an indicator of the conditions which underlie erectile dysfunction. If you have heart disease, you're about two times as likely to have erection problems.

Source: Johannes CB, Araujo AB, Feldman HA, et al.
Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. Journal of Urology. 2000; 163: 460-463.

High blood pressure

Normal blood pressure is defined as being no higher than 140/90. If the first number - the systolic pressure - is above 140 or the second - the lower, or diastolic, pressure is above 90, a person is described as having high blood pressure or "hypertension." Hypertension can cause erection problems.

Source: Johannes CB, Araujo AB, Feldman HA, et al.
Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. Journal of Urology. 2000; 163: 460-463.

Other drugs can also cause erection problems

Source: Miller TA. Diagnostic evaluation of erectile dysfunction. American Family Physician. 2000; 61: 95-104, 109-110. These include:

Antidepressants. Doctors sometimes prescribe them for other conditions, too.

Benzodiazepines.

Drugs for schizophrenia and other mental illnesses (antipsychotics).

Drugs for heartburn and acid reflux, including H2 blockers.

Drugs for seizure - a seizure, or unexpected and sudden spasm of bodily muscles resulting form abnormal electrical activity in the brain can be treated with phenobarbital and phenytoin.

Anti-fungal drugs to treat conditions such as candida and cryptococcus, and antibiotics such as  ketoconazole.

Injuries to the groin or spine

These can be a cause of erectile dysfunction. The spinal cord nerves run along the backbone and are protected by the bones of the spine. If the nerves of the spinal cord are somehow  damaged, one of the consequences may be the onset of erection problems.

Cigarettes

This may be a risk factor for erectiel dysfunction.

Source: Feldman HA, Goldstein I, Hatzichristou DG, et al.
Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Journal of Urology. 1994; 151: 54-61.
Smoking also makes erection problems much worse if you happen to suffer from heart disease, high blood pressure or arthritis (an inflammatory condition of the joints, osteoarthritis being the most common type).

Source: McVary KT, Carrier S, Wessells H, et al.
Smoking and erectile dysfunction: evidence based analysis. Journal of Urology. 2001; 166: 1624-1632.

Smoking can also be a factor in the onset of atherosclerosis, which, as we have seen above, can lead to erection problems.

Alcohol consumption

Studies have shown that regular consumption of excess can predispose you to erection problems.

Source:  Bortolotti A, Parazzini F, Colli E, et al.
The epidemiology of erectile dysfunction and its risk factors. International Journal of Andrology. 1997; 20: 323-334.

Drug use

Marijuana, cocaine and various other illegal drugs can predispose you to erection problems.

Source: Bortolotti A, Parazzini F, Colli E, et al.
The epidemiology of erectile dysfunction and its risk factors. International Journal of Andrology. 1997; 20: 323-334.

Sources for the information on this page:

1.Feldman HA, Goldstein I, Hatzichristou DG, et al.Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.Journal of Urology. 1994; 151: 54-61.
2.Johannes CB, Araujo AB, Feldman HA, et al.Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study.Journal of Urology. 2000; 163: 460-463.
3.Miller TA.Diagnostic evaluation of erectile dysfunction.American Family Physician. 2000; 61: 95-104, 109-110.
4.Meuleman EJ.Prevalence of erectile dysfunction: need for treatment?International Journal of Impotence Research. 2002; 14 (supplement 1): S22-S28.
5.McVary KT, Carrier S, Wessells H, et al.Smoking and erectile dysfunction: evidence based analysis.Journal of Urology. 2001; 166: 1624-1632.
6.Bortolotti A, Parazzini F, Colli E, et al.The epidemiology of erectile dysfunction and its risk factors.International Journal of Andrology. 1997; 20: 323-334.


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Other sources of information on erection problems and impotence, their treatment and the cures:

WebMD on erectile dysfunction

Mayo Clinic on erectile dysfunction