Can erectile dysfunction be a sign of heart disease?

Cardiovascular diseases are conditions affecting the heart and blood vessels [1]. According to the World Health Organization, cardiovascular diseases represent the leading causes of death globally [1,2]. 

There are multiple risk factors for the development of heart disease, which can be split into: 

• Modifiable risk factors – these are factors and behaviours we can change.
• Non-modifiable risk factors – these are factors we cannot change, such as age and biological gender [1,2].

There is a longstanding belief that men suffer from heart disease more than women [1,2], but is it that simple? 

We look at the latest evidence base, delve into an emerging branch of medicine known as ‘gender medicine’ [3], and discover whether there is an association between heart health and erectile dysfunction. 

What is erectile dysfunction?

Erectile dysfunction (ED) can be defined as an inability to obtain and/or maintain an erection for sexual intercourse [4]. 

Historically, ED is sometimes also referred to as impotence and can have a variety of underlying causes. As sexual intercourse is a regular part of many relationships, ED carries emotional and psychological stigma [4]. 

Is erectile dysfunction a warning sign of heart disease?

There are many causes of erectile dysfunction, including psychological, physiological (relating to the function of our body or bodily organs), and iatrogenic (caused by medical assessment or treatment). 

Psychological causes include conditions such as:

• Depression 
• Anxiety
• Performance anxiety, particularly common with a new partner (4) 

Physiological causes include conditions such as: 

• High blood pressure
• Atherosclerosis (thickening of arterial walls due to high cholesterol)
• Diabetes
• Hormonal problems such as low testosterone or thyroid dysfunction
• Neurological problems such as stroke, multiple sclerosis, or nerve damage from back or pelvic trauma [4,5]

Iatrogenic causes include:

• Certain medications used to treat leg swelling known as diuretics
• Some antidepressant medications
• Heart medications such as beta-blockers 
• Methadone maintenance treatment
• Medical investigations and surgical procedures that affect the prostate [4,5] 

Ultimately, cardiovascular disease accounts for the majority of causes of ED, with atherosclerosis being responsible for up to 50% of cases and high blood pressure representing the next most common cardiac cause of ED. 

The link between poor cardiovascular health and erectile dysfunction is clear but not exclusive (5). 

What are the treatment options for erectile dysfunction?

Treatment for ED often starts with addressing the underlying cause. 

• Managing health conditions - For diabetics, blood sugar control is essential to minimising nervous damage from longstanding high blood sugar levels. If you have high blood pressure or high cholesterol, management and regular check-ups of blood pressure and cholesterol are essential. 
• Medications - Symptomatic relief is often achieved by taking medications, such as Viagra, before sexual intercourse, or by applying Alprostadil as an injection or pellet inside the urethra (the tube where urine leaves the body). Talk to your doctor before taking anything. They may contraindicate with certain other medications and medical conditions, especially angina (which causes chest pain) and low blood pressure [6]. 
• Vacuum devices - Vacuum devices tend to help more with the ability to maintain an erection rather than to obtain an erection. These devices can be used, sometimes in addition to medication, to help achieve and maintain an erection. 
• Surgery - Surgical intervention serves as a last resort. This generally involves the insertion of a prosthetic implant and is reserved for patients who have not responded to medications or vacuum devices. 

Always get checked for underlying causes of ED before starting treatment. This helps to make sure that you are prescribed safe, licensed medication. 

The internet is full of medications that claim to enhance male sexual performance. But, to obtain these medications safely, you should always speak to your doctor or pharmacist to find out whether medication could help. They will be able to advise and supply you appropriately. 

An ideal starting point for investigating the root cause of ED could be an Erectile Dysfunction Blood Test with a personalised report from one of our doctors. 

Are men more at risk of heart disease than women?

Gender medicine is the emerging branch of medicine that studies the effect of sex or gender on general health [3]. The emergence of this discipline has highlighted that men and women often present differently for some health conditions, and heart disease is at the forefront of this variation [3]. 

It is well established that the death rate from cardiovascular disease is lower in women regardless of economic, social and cultural factors [7]. However, it is now becoming increasingly clear that healthcare workers have not always been aware of the different symptoms that women may present. This may have resulted in many women going undiagnosed, significantly skewing the global data on cardiovascular diseases, as well as other conditions [7]. 

How can heart disease present? 

Cardiovascular disease is an umbrella term that refers to a group of conditions affecting the heart and blood vessels [1]. However, we now know there is variation in how these conditions can present in men and women.  

General signs of heart disease in men and women include:

• Chest pain 
• Breathlessness 
• Palpitations (or a feeling of your heart racing)
• Dizziness 
• Tiredness [9] 

How to take care of your heart health

Key modifiable risk factors for cardiovascular disease in both men and women include:

• Obesity
• High blood pressure
• Tobacco smoking
• Excessive alcohol intake
• High cholesterol
• High-stress levels
• Diabetes, if poorly controlled

Maintaining a healthy weight through eating a nutritious, balanced diet with restricted salt and saturated fat intake [8] and taking part in regular exercise can help take care of heart health. 

Avoidance of smoking or smoking cessation is also strongly recommended, and alcohol should be consumed in moderation [9]. 

If you have high blood pressure, you should regularly monitor it and actively engage with any prescribed treatment. Similarly, for diabetics, regular home diabetic monitoring, blood sugar control, and attending diabetic health checks are all essential components to minimise the risk of future heart disease. 

Cholesterol and heart health

Healthy cholesterol levels are essential to heart health. The good news is that this is something that many of us can manage through diet, exercise and smoking avoidance. In some cases, medications, such as statins, are needed to maintain healthy cholesterol levels [4]. 

• A Cholesterol Blood Test can help you keep on top of your cholesterol level. 
• Get a more comprehensive assessment with our Heart Disease Risk Blood Test. This also assesses for inflammation, with higher levels of inflammation also being linked to an increased risk of heart disease [10].

Cardiovascular diseases and your heart

In summary, we have learnt that cardiovascular diseases affect the heart and blood vessels. This group of diseases all present slightly differently, and there is further variation between men and women. 

There are multiple risk factors for developing heart disease. The most influential controllable risk factors are diet, exercise, blood sugar, blood pressure, and avoidance of smoking and excessive stress [9]. 

Over half of the causes of ED are related to atherosclerosis, the most common cardiac cause of ED. Other causes are numerous and should be investigated before seeking treatment. 

While men are more prone to developing (and dying from) heart disease than women ([11], it is also logical to conclude that some of this difference may be due to the difference in presenting symptoms of men and women. 

Ultimately, cardiovascular disease remains a leading cause of death in both men and women, and we should all strive to take steps to minimise our risk [1,2]. 

Men’s health checks

For an overall men’s health check, our Advanced Well Man Blood Test offers an excellent overview of your current health and includes tests for heart disease risk, liver and kidney health, and diabetes. It also tests your level of testosterone, the male hormone responsible for libido, muscle mass, and male fertility. 

References

1. WHO, 2022. [online] Available at: <https://www.who.int/health-topics/cardiovascular-diseases> [Accessed 26 January 2022].
2. Who.int. 2022. Cardiovascular diseases (CVDs). [online] Available at: <https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)> [Accessed 26 January 2022].
3. Shai, A., Koffler, S. and Hashiloni-Dolev, Y., 2021. Feminism, gender medicine and beyond: a feminist analysis of "gender medicine." International Journal for Equity in Health, 20(1).
4. Yafi, F., Jenkins, L., Albersen, M., Corona, G., Isidori, A., Goldfarb, S., Maggi, M., Nelson, C., Parish, S., Salonia, A., Tan, R., Mulhall, J. and Hellstrom, W., 2016. Erectile dysfunction. Nature Reviews Disease Primers, 2(1).
5. Knott, D., 2022. Erectile Dysfunction. Causes; treatment of erectile dysfunction. [online] Patient.info. Available at: <https://patient.info/doctor/erectile-dysfunction> [Accessed 26 January 2022].
6. Bhf.org.uk. 2022. Let’s talk about... erectile dysfunction. [online] Available at: <https://www.bhf.org.uk/informationsupport/heart-matters-magazine/wellbeing/erectile-dysfunction> [Accessed 26 January 2022].
7. Bots SH, Peters SAE, Woodward M, Sex differences in coronary heart disease and stroke mortality: a global assessment of the effect of ageing between 1980 and 2010, BMJ Global Health 2017;2:e00029
8. Nhlbi.nih.gov. 2022. DASH Eating Plan | NHLBI, NIH. [online] Available at: <https://www.nhlbi.nih.gov/education/dash-eating-plan> [Accessed 26 January 2022].
9. British Heart Foundation. 2022. Cardiovascular heart disease. [online] Available at: <https://www.bhf.org.uk/informationsupport/conditions/cardiovascular-heart-disease> [Accessed 26 January 2022].
10. Uptodate.com. 2022. UpToDate. [online] Available at: <https://www.uptodate.com/contents/overview-of-established-risk-factors-for-cardiovascular-disease?search=inflamation%20and%20heart%20disease&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4#H4482486> [Accessed 26 January 2022].
11. Harvard Health. 2022. Throughout life, heart attacks are twice as common in men than women - Harvard Health. [online] Available at: <https://www.health.harvard.edu/heart-health/throughout-life-heart-attacks-are-twice-as-common-in-men-than-women> [Accessed 26 January 2022].