Erectile dysfunction may be sign of coming heart disease

Jan 10 2006

Most wives would say their husbands are notoriously bad about avoiding the doctor’s office. Erectile dysfunction (ED) might be the only problem that prompts some men to go to a physician. According to a new study, it could be their best chance at finding out they have underlying cardiovascular disease.

Lead author of the study, released in the Journal of the American Medical Association (JAMA), is Ian M. Thompson Jr., M.D., professor and chairman of the department of urology at the U T Health Science Center.

“This analysis looked at two groups of men who were enrolled in the landmark Prostate Cancer Prevention Trial,” Dr. Thompson said. “One group of men reported having trouble with ED before they enrolled in the PCPT. The other group of men developed ED after enrollment. None of the men had ever suffered a heart attack, chest pain or stroke before enrolling in the trial. All of the men were on the placebo group of the trial.

“We demonstrated that the men with previous history of ED were statistically more likely to develop cardiovascular disease. The men who had no ED at enrollment but developed it during the trial also showed significantly greater risk of cardiovascular disease.”

The project looked at more than 8,000 men who were evaluated for ED and cardiovascular disease every three months during the seven-year prevention trial. Statistical analysis showed the group who developed ED after they enrolled in the study had a 25 percent increased risk of subsequent heart disease. When these men and the men with ED at the time they began the study were analyzed, together they had a 45 percent greater risk of heart disease.

“The whole point is, when a man goes to see a doctor and says he is having trouble with ED, this comment should make the doctor think about heart disease risk factors, just as if the man said that his father died of heart disease,” Dr. Thompson said. “The man should be screened for cardiovascular risk factors such as blood pressure, lipid levels, smoking and obesity. ED is an independent risk factor, in the same league with risk factors such as family history of heart disease.”

Cardiovascular disease remains the most frequent cause of death and disability in the U.S. An estimated 1.2 million heart attacks with 500,000 deaths will occur this year. The first symptom of cardiovascular disease generally is death, a heart attack or a stroke.

Severe blockage of the arteries of the heart, legs or brain is the cause of heart attack or stroke, but an earlier problem occurs at the level of the cells lining the artery. One of the earliest changes to occur is spontaneous narrowing of arteries and failure of the artery to dilate to allow more blood flow to occur, said Steven R. Bailey, M.D., professor of cardiology at the Health Science Center. This may occur months or years prior to any evidence of heart or brain disease.

“Dr. Thompson and his colleagues have provided patients and physicians a new tool to help evaluate and treat patients with cardiovascular disease earlier than ever before,” Dr. Bailey said. “Erectile dysfunction is not only a strong predictor of eventually having cardiovascular disease, it also predicts the fact that it will occur earlier than other factors previously identified.”

He said he hopes all physicians will incorporate a diagnosis of ED into their screening for cardiovascular disease.

“This kind of observation has the potential to save many lives,” Dr. Thompson added. “Unlike women, men frequently don't have annual checkups. With the increased interest in erectile dysfunction, primarily because we now have good drugs to treat it successfully, this may be the first time a man ever sees a doctor. That doctor has the opportunity to say, ‘Let’s go one step further and look at heart disease.’ That has the potential to save many men from sudden death.”

ED affects as many as 10 million men in the U.S. and 100 million worldwide.

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