Erectile Trouble May Signal Heart Disease

Studies suggest men with ED get checked for vascular problems

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HealthDay Reporter

TUESDAY, May 24, 2005 (HealthDayNews) -- Many men with erectile dysfunction may face an even tougher health problem: heart disease.

That's the conclusion of a number of studies presented Tuesday at the American Urological Association (AUA) annual meeting in San Antonio. All found strong connections between the two conditions.

In one paper, Austrian researchers note a relationship between high blood levels of homocysteine, an amino acid marker for heart disease, and erectile dysfunction.

The researchers found that 20 of the 30 patients with erectile dysfunction they studied also had high homocysteine levels.

"Erectile dysfunction and cardiovascular disease are connected, and homocysteine is a marker for cardiovascular disease," lead researcher Dr. Ralf Herwig, a consultant at Urology Clinic Innsbruck University Hospital, said at a news conference Tuesday. "Testing of homocysteine may be able to identify patients with the risk of erectile dysfunction."

"Levels of homocysteine may be a sign of how severe erectile dysfunction is," he added.

"If you have a patient with erectile dysfunction and high homocysteine, then you can treat the patient as an erectile dysfunction patient but send them to a specialist that is looking after the vessels in the heart," Herwig advised.

Simple dietary changes may also help reduce homocysteine levels. "Nutrition can influence homocysteine levels positively, and substitution with folic acid, in combination with vitamin B6 and B12, can reduce homocysteine levels significantly," the researchers pointed out in their study. "Further studies have to show if vitamin supplementation can possibly help in therapy of erectile dysfunction."

In another paper presented at the meeting, Italian researchers sought to pinpoint those specific types of heart disease associated with erectile problems.

Among 162 patients with heart disease, 46 percent had erectile dysfunction, according to researchers at the University Vita-Salute San Raffaele, in Milan. They noted that among the patients with chronic angina, 71 percent experienced erectile dysfunction for a little over a year before being diagnosed with heart disease.

Factors most predictive of erectile dysfunction included being older, prior heart attack and a diagnosis of two to three blocked coronary arteries. Furthermore, patients with a history of heart attack plus erectile dysfunction were at a sixfold increased risk of having several blocked coronary arteries, the researchers noted.

"Erectile dysfunction prevalence differs across subsets of patients with coronary artery disease and is related to extent of coronary artery disease and type of clinical presentation," the Italian team wrote. "It is high in chronic angina with multi-vessel disease and low in heart attack with one-vessel disease as result of clinical conditions with different atherosclerotic burdens."

"This isn't so very new," Dr. Ira Sharlip, a spokesman for the AUA, told the news conference. "This study shows with advancing coronary disease there is a greater likelihood of erectile dysfunction. That's been shown before."

He added, however, "Erectile dysfunction is probably a marker for cardiovascular disease. Patients who have erectile dysfunction should be in the hands of physicians who can evaluate them for coronary disease."

In a third presentation, investigators from Germany reported that Viagra, the male impotency drug, improved circulation in small blood vessels and also improved vessel function in patients with coronary artery disease.

"If endothelial dysfunction is defined as a disease, and if it should be treated, a drug like sildenafil could be used," said lead researcher Dr. Jai-Wun Park, from the Cardiovascular Institute at the Technical University in Dresden.

One erectile dysfunction expert said most of these findings come as no surprise.

"I often start my patients on folate to reduce homocysteine," noted Dr. Kevin Billups, medical director of the Epicenter for Sexual Health Medicine in Edina, Minn. "We also found that men with erectile dysfunction have higher levels of C-reactive protein [another blood marker for heart disease risk]."

He recommends that patients with erectile problems get checked early for possible cardiovascular disease. "If you have erectile difficulty, and if it persists for three to six months, you really need to go in and get treated not only for your erectile dysfunction, but also get a good basic evaluation of blood pressure, weight, blood," he said.

"Don't just write erectile dysfunction off as being tired or being stressed," Billups said. "It's usually part of a vascular issue. If men would come in when they first experience erectile dysfunction, we would pick up cardiovascular disease at a much earlier clip."

More information

The National Institute of Diabetes and Digestive and Kidney Diseases can tell you more about erectile dysfunction.

SOURCES: Ralf Herwig, M.D., consultant, Urology Clinic Innsbruck University Hospital, Austria; Ira Sharlip, M.D., spokesman, American Urological Association, and assistant clinical professor, urology, University of California, San Francisco; Jai-Wun Park, M.D., Cardiovascular Institute at the Technical University, Dresden, Germany; Kevin Billups, M.D., medical director, Epicenter for Sexual Health and Medicine, Edina, Minn., and adjunct assistant professor, urology, University of Minnesota, Minneapolis; May 24, 2005, presentations, American Urological Association annual meeting, San Antonio

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