By now, most people are familiar with the factors that can increase the risk of having a heart attack: gaining too much weight, having high blood pressure or high cholesterol levels, smoking and not exercising enough.
In a study published Monday in the journal Circulation, researchers say they have documented another risk factor that could help identify men at greatest risk of heart problems: Among a group of 1,900 men aged 60 to 78, those with erectile dysfunction were twice as likely as men without the condition to have a heart attack, stroke, or die of a heart problem.
Around 20% of men over age 20 experience erectile dysfunction in the U.S., and the rates are higher among older men. The causes of the condition can vary and include stress-related psychological factors as well as physical and biological factors involving blood flow and nerves.
Previous studies have linked similar risk factors responsible for contributing to heart disease to erectile dysfunction as well, including obesity, high blood pressure, atherosclerosis, high cholesterol lack of physical activity and smoking.
But researchers have had difficulty figuring out whether erectile dysfunction is a symptom of heart-related circulation problems, or whether the condition is itself a possible contributor to heart disease. In the latest study, Dr. Michael Blaha, director of clinical research for the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, and his colleagues did the most rigorous analysis yet to account for the potentially confounding factors. They ultimately found that erectile dysfunction is indeed a risk factor for heart disease.
The researchers adjusted for the effects of obesity, smoking, high blood pressure and high cholesterol levels, among other factors, which can contribute to both erectile dysfunction and heart disease. Even after accounting for these factors, they found that erectile dysfunction contributed independently to a higher risk of heart problems.
“I think we can say with certainty now that erectile dysfunction has an independent risk predictor value above the routine risk factors like smoking, cholesterol and blood pressure,” says Blaha. “The diagnosis of erectile dysfunction adds to the risk profile on top of those factors.”
Blaha says that the results should serve as a warning to both men and the doctors who treat them, since current guidelines don’t include erectile dysfunction as a risk factor for heart disease. That means that urologists who normally treat men for the condition should be open to referring their patients to heart experts, who can asses them for possible signs of early heart disease. Furthermore, heart doctors should inquire about male patients’ functionality. “We should be asking about erectile function as a general health concern, because it’s a risk factor and a treatable condition,” says Blaha.
He stresses that treating erectile dysfunction is not a treatment for heart disease. Medications like Viagra can only treat problems with priapism, but do not address underlying heart-related issues, which is why men with erection problems should be encouraged to see a heart doctor.
But identifying men who might be at higher risk of heart problems, even if they aren’t experiencing any symptoms, could save lives. The U.K. already includes erectile dysfunction as part of an algorithm for calculating heart disease risk; Blaha believes the U.S. should make similar changes in the next set of heart risk recommendations. “We are at that point where if it is identified, then it should be considered another risk factor for heart disease,” says Blaha. If men whose hearts are at higher risk are identified early, thanks to erectile dysfunction, then that could potentially lead to lower rates of heart disease and heart-related deaths.