Doctors should ask men about erectile dysfunction, can predict heart disease

Provided by: The Canadian Press
January 23, 2006

TORONTO -It's a subject many guys are loathe to discuss, but questions about erectile dysfunction should be part of annual checkups by family doctors - and not just to ensure a man is sexually healthy, a Canadian study suggests.

That's because the presence of erectile dysfunction raises a red flag, as it were, for an elevated risk of heart disease, stroke and diabetes, a number of recent studies have found.

"Asking for a sexual history of a patient and determining to what degree their sexual function is normal is an important part of not only understanding their sexual health, but perhaps on a much broader level, their cardiovascular health, as well," said lead author Dr. Steven Grover, director of McGill University's cardiovascular improvement program.

"I think the most interesting part of our analysis is that even among those individuals who didn't have known cardiac disease - in other words, nobody had ever told them they had a heart problem - the presence of erectile dysfunction is still strongly associated with their risk of future coronary disease," Grover said Monday from Montreal.

The study, one of three on erectile dysfunction published in Tuesday's issue of the Archives of Internal Medicine, involved almost 4,000 men who visited one of 75 primary-care physicians across Canada between July 2001 and November 2002. Participants provided medical histories, were given physical exams and had levels of glucose and lipids (cholesterol and other fats) measured in their blood.

Almost half the men, ranging in age from 40 to 88, reported having experienced erectile dysfunction (ED) in the four weeks prior to their visit or said they were taking medication to treat the sexual problem. Age was the biggest predictor of the condition: in men 70 or older, 85 per cent suffered from ED, while it affected less than a third of those 40 to 49.

Men with cardiovascular disease or diabetes were most likely to have erectile dysfunction, concluded the study, the first to look at its prevalence in the general community, through routine visits to doctors' offices.

The study also found that among those men who had no symptoms of heart disease or diabetes, their calculated risk of going on to develop one or both conditions was linked to their likelihood of having ED, the authors say.

Yet erection difficulties are often kept under wraps, especially by younger patients, and doctors also tend to avoid the subject, Grover said.

"It's embarrassing and who wants to get into that area?" he said. "But I think that now there's an added incentive because it's saying to patients, 'Not only is this important from a sexual health perspective, but it may actually be much more important from a general health perspective.'

"At the end of the day, cardiovascular disease still remains the Number 1 killer in Canada."

Grover said that the same arteriosclerosis (a narrowing of blood vessels from plaque buildup), which can potentially lead to a heart attack and/or stroke, is likely occurring in blood vessels in the penis, which must dilate for an erection to occur.

That's how Viagra, Levitra and other ED drugs work, by allowing penile blood vessels to expand. But although they work well to relieve symptoms, the medications don't eliminate the cause, he said.

"If you've cured the symptoms but haven't paid attention to why you've developed the problem in the first place, you're really doing yourself a disservice."

In a study led by researchers at the University of California, Los Angeles, the overall prevalence of erectile dysfunction in the United States was found to be 18.4 per cent among all age groups, with 77.5 per cent of men aged 75 or older reporting the condition; just 6.5 per cent of men aged 20 to 29 were affected.

In a second U.S. study, which involved men referred for heart-related stress testing, University of Chicago researchers found that patients with erectile dysfunction were more likely to have heart disease, diabetes and high blood pressure. Stress test results also suggested a high risk for cardiovascular disease.

"Erectile dysfunction is a stronger predictor than traditional coronary heart disease risk factors in this population," the authors write. "Sexual function questioning may be useful to stratify risk in patients suspected to have coronary heart disease. Further studies are needed to establish whether patients with ED but no cardiac symptoms should be screened for overt coronary heart disease."

Grover said exercise programs aimed at boosting cardiovascular health have been found to relieve erectile dysfunction, so it's likely that other heart-healthy measures - among them, not smoking, maintaining a healthy weight and blood pressure, and keeping cholesterol levels in check - likely also would improve a man's potential in the bedroom.

"The good news," he said "is that many of these risk factors are treatable."

The Canadian Study of Erectile Dysfunction (CANSED) was funded by Pfizer, maker of Viagra.