Summary:
Erectile Dysfunction and the Heart
How common is erectile dysfunction in men with heart problems?
Prepare yourself for a shocking statistic: a recent study in the Journal of Urology by Kloner et al found that 75% of men with chronic heart disease suffer from erectile dysfunction. In this study, 75% of cardiac patients admitted to some difficulty achieving erections. 67% admitted to difficulty maintaining an erection after penetration. Previous studies yielded similar results in post-heart attack and bypass patients.
Why do so many men with heart problems have erectile dysfunction?
Erectile dysfunction and heart disease share many of the same risk factors, such as high blood pressure, smoking, diabetes, obesity, cholesterol problems, and lack of physical activity. Each of these risk factors contributes to permanent or semi-permanent changes in the blood vessels. Healthy blood vessels are necessary, not only to ensure an adequate blood supply to the heart, but also to take join nerves, hormones, and tissues in the complex interactions required for an erection.
The other reason men with heart problems may have erectile dysfunction relates to their medications. Ironically, many medications which treat the risk factors for heart disease (and erectile dysfunction) can make erectile dysfunction worse. The worst offenders in this category are blood pressure and cholesterol lowering medications. Thiazide diuretics, beta blockers, statins, and fibrates have each been observed to have erectile dysfunction as a potential side effect. Interestingly, two recent studies have suggested that the class of blood pressure medications called angiotensin receptor blockers may improve erectile dysfunction. Don’t throw out those medications yet, though - there is a way to help your heart and keep erectile dysfunction at bay.
Can men with heart problems take medications for erectile dysfunction?
Most men can. PDE5 inhibitors, the class of medications to which Viagra belongs, has been shown to be safe and effective in men with stable heart disease and have few side effects. Your doctor can determine whether you are a candidate for these medications using guidelines approved by the American College of Cardiology/American Heart Association and Princeton. The major contraindication to taking these medications is if you are taking nitrates, such as nitroglycerin, for help with anginal symptoms.
Can lifestyle changes improve erectile function?
Exercising and quitting smoking are the two lifestyle changes that have been shown to improve erectile function. One study found that minimizing risk factors shared by heart disease and erectile dysfunction in patients taking sildenafil (Viagra) actually enhanced the effectiveness of the medication.
Wait just a minute now - should men with heart problems even be having sex to begin with?
Studies have shown that the risk of a heart attack is slightly higher in patients with heart problems than in the general population. However, that risk is still very low. If you, your spouse, or your doctor is concerned about this possibility, do an exercise stress test. If you can reach three to six mets without chest pain, EKG or echocardiogram changes, then you are at low risk for having a heart attack during sex.
If it’s safe to have sex and treatment is safe, why aren’t more men with heart problems being treated for erectile dysfunction?
The answer to this question boils down to simple embarrassment. Patients are often reluctant to bring up the issue, and most cardiologists don’t ask their patients about erectile dysfunction. Even primary care doctors do not ask about it enough. The authors of the first study mentioned made this excellent recommendation: doctors should ask heart patients about erectile dysfunction, and erectile dysfunction patients about their risk factors for heart disease.
Could treating erectile dysfunction actually help the heart?
In theory, the answer is yes. By adequately treating erectile dysfunction, patients might be more likely to stay on their blood pressure medications. This measure alone could reduce the incidence of stroke, heart attack, left-sided heart enlargement, heart failure, and end-stage kidney disease. It has also been shown that treatment of erectile dysfunction can result in improved mood and lower rates of depression. Given the relationship between heart attacks and depression, it is possible that treating depression indirectly by treating erectile dysfunction will lower the risk of heart attack. While future studies are needed to explore these possibilities, right now it is clear that that an open and unembarrassed discussion of erectile dysfunction will improve the quality of life in patients with heart problems.
What about external counterpulsation for erectile dysfunction?
External counterpulsation has been FDA and HCFA approved for treating patients with angina which is not treatable by coronary bypass surgery or angioplasty. External counterpulsation has been shown to be successful in treating patients with erectile dysfunction.
