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Erectile woes may portend heart disease

May 19, 2008
Courtesy American College of Cardiology
and World Science staff

Erec­tile dys­func­tion is al­ways a mat­ter of the heart, but new re­search sug­gests more than ro­mance is at stake. Two new stud­ies of men with type 2 di­a­be­tes found that erec­tile dys­func­tion was a pow­er­ful early warn­ing sign for se­ri­ous heart dis­ease, in­clud­ing heart at­tack and death.

One of the stud­ies al­so sug­gested cho­les­ter­ol-lowering med­ica­t­ions could cut the risk of heart prob­lems by about a third, and that Vi­a­gra and re­lat­ed com­pounds might of­fer si­m­i­lar pro­tec­tion. 

Re­search­ers said the find­ings un­der­score that men should re­port erec­tile dys­func­tion to their doc­tors, and that treat­ment should fo­cus not only on the sex­u­al prob­lem but al­so on car­di­o­vas­cu­lar health. The re­search is pub­lished in the May 27 is­sue of the Jour­nal of the Amer­i­can Col­lege of Card iol­ogy.

“E­rec­tile dys­func­tion should alert both pa­tients and health­care providers to the fu­ture risk of cor­o­nary heart dis­ease,” said Pe­ter Chun-Yip Tong of the Chin­ese Uni­ver­s­ity of Hong Kong. “Other risk fac­tors such as poor blood glu­cose con­trol, high blood pres­sure, high cho­les­ter­ol lev­els, smok­ing and obes­ity should be re­viewed and ad­dressed ag­gres­sive­ly.”

Di­a­be­tes, erec­tile dys­func­tion and heart dis­ease of­ten share an om­i­nous link, he said: dam­age to blood ves­sels by high blood sug­ar lev­els. The same pro­cess that hin­ders the ex­tra blood flow needed for an erec­tion can have more dire con­se­quenc­es in the heart. 

“The first event is probably en­do­the­lial dys­func­tion—when the smooth­ness and re­ac­ti­vity of the blood ves­sel are dam­aged,” said Tong. “This pro­cess en­cour­ages lo­cal in­flamma­t­ion on the in­ner sur­face of the blood ves­sels and the dep­o­si­tion of cho­les­ter­ol, re­sult­ing in forma­t­ion of clots and ath­er­o­scle­ro­sis. There­fore, there is a high risk of block­age of blood ves­sels in the heart, which can lead to a heart at­tack.”

Tong said men typ­ic­ally show signs of erec­tile dys­func­tion, or ED, more than three years be­fore symp­toms of cor­o­nary heart dis­ease—the dom­i­nant cause of heart-re­lat­ed deaths, in­clud­ing heart at­tack. In one study of di­a­bet­ic men, ED symp­toms al­ways pre­ced­ed cor­o­nary symp­toms, he said.

In a Hong Kong-based stu­dy, Tong and col­leagues re­cruited 2,306 men with type 2 di­a­be­tes, a fourth of whom had ED and none of whom had any signs or his­to­ry of heart dis­ease, vas­cu­lar dis­ease or stroke. The re­search­ers fol­lowed up the pa­tients for an av­er­age of four years. Dur­ing that time, 123 men died from or de­vel­oped signs of cor­o­nary heart dis­ease.

An en­su­ing anal­y­sis found that ED sig­naled a 58 per­cent in­crease in the risk of cor­o­nary heart dis­ease. Just one oth­er warn­ing sign was stronger, the re­search­ers said: spill­age of abun­dant pro­tein in the urine, which dou­bles heart dis­ease risk and sig­nals ex­ten­sive kid­ney dam­age.

In a sec­ond stu­dy, re­search­ers from four med­ical cen­ters in Italy fo­cused on 291 men who had type 2 di­a­be­tes as well as “si­lent” CHD dis­cov­ered by test­ing. Of these, 118 had ED at the be­gin­ning of the stu­dy. 

The re­search­ers fol­lowed up pa­tients for an av­er­age of nearly four years, doc­u­ment­ing not only signs of cor­o­nary heart dis­ease but al­so re­lat­ed events such as stroke, mini-stroke and ar­te­ri­al dis­ease in the legs. They found that pa­tients who had ED at the be­gin­ning of the study were twice as likely to suf­fer such events.

The study al­so found the risk dropped by a third for pa­tients tak­ing cho­les­ter­ol-lowering drugs known as statins. Vi­a­gra and oth­er med­ica­t­ions in a family known as 5-phosphodiesterase in­hibitors al­so ap­peared to re­duce the risk; but this re­sult fell slightly short of be­ing sta­tis­tic­ally sig­nif­i­cant, the re­search­ers said, sug­gest­ing a need for fur­ther in­ves­ti­ga­t­ion.

“These are im­por­tant stud­ies,” said Rob­ert A. Kloner of the Keck School of Med­i­cine at the Uni­ver­s­ity of South­ern Cal­i­for­nia, who was not in­volved in the re­search. “Men should know that ED is a true har­bin­ger of ath­er­o­scle­ro­tic cor­o­nary heart dis­ease.” Kloner, who wrote an ed­i­to­ri­al about the new stud­ies in the same is­sue of the jour­nal, not­ed that aside from con­sid­era­t­ions of what med­ica­t­ions to use, it’s al­so crit­i­cal for pa­tients to con­trol blood pres­sure and oth­er heart dis­ease risk fac­tors.


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Erectile dysfunction is always a matter of the heart, but new research suggests more than romance is at stake. Two new studies of men with type 2 diabetes found that erectile dysfunction was a powerful early warning sign for serious heart disease, including heart attack and death. One of the studies also suggested cholesterol-lowering medications could cut the risk of heart problems by about a third, and that Viagra and related compounds might offer similar protection. Researchers said the findings underscore that men should report erectile dysfunction to their doctors, and that treatment should focus not only on the sexual problem but also on improving cardiovascular health. The research is published in the May 27 issue of the Journal of the American College of Cardiology. “Erectile dysfunction should alert both patients and healthcare providers to the future risk of coronary heart disease,” said Peter Chun-Yip Tong of the Chinese University of Hong Kong. “Other risk factors such as poor blood glucose control, high blood pressure, high cholesterol levels, smoking and obesity should be reviewed and addressed aggressively.” Diabetes, erectile dysfunction and heart disease often share an ominous link, he said: damage to blood vessels by high blood sugar levels. The same process that hinders the extra blood flow needed for an erection can have more dire consequences in the heart. “The first event is probably endothelial dysfunction—when the smoothness and reactivity of the blood vessel are damaged,” said Tong. “This process encourages local inflammation on the inner surface of the blood vessels and the deposition of cholesterol, resulting in formation of clots and atherosclerosis. Therefore, there is a high risk of blockage of blood vessels in the heart, which can lead to a heart attack.” Tong said men typically show signs of erectile dysfunction, or ED, more than three years before symptoms of coronary heart disease appear—the dominant cause of heart-related deaths, including heart attack. In one study of diabetic men, ED symptoms always preceded coronary symptoms, he said. In a Hong Kong-based study, Tong and colleagues recruited 2,306 men with type 2 diabetes, a fourth of whom had ED and none of whom had any signs or history of heart disease, vascular disease or stroke. The researchers followed up the patients for an average of four years. During that time, 123 men died from or developed signs of coronary heart disease. An ensuing analysis found that ED signaled a 58 percent increase in the risk of coronary heart disease. Just one other warning sign was stronger, the researchers said: spillage of abundant protein in the urine, which doubles heart disease risk and signals extensive kidney damage. In a second study, researchers from four medical centers in Italy focused on 291 men who had type 2 diabetes as well as “silent” CHD discovered by testing. Of these, 118 had ED at the beginning of the study. The researchers followed up patients for an average of nearly four years, documenting not only signs of coronary heart disease but also related events such as stroke, mini-stroke and arterial disease in the legs. They found that patients who had ED at the beginning of the study were twice as likely to suffer such events compared to others. The study also found the risk dropped by a third for patients taking cholesterol-lowering drugs known as statins. Viagra and other medications in a family known as 5-phosphodiesterase inhibitors also appeared to reduce the risk; but this result fell slightly short of being statistically significant, the researchers said, suggesting a need for further investigation. “These are important studies,” said Robert A. Kloner of the Keck School of Medicine at the University of Southern California, who was not involved in the research. “Men should know that ED is a true harbinger of atherosclerotic coronary heart disease.” Kloner, who wrote an editorial about the new studies in the same issue of the journal, noted that aside from consideration of what medications to use, it’s also critical to control blood pressure and other heart disease risk factors.