Erectile Dysfunction May Signal Heart Disease

Study ties it to artery problems in younger, healthy men

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HealthDay Reporter

TUESDAY, Jan. 20, 2004 (HealthDayNews) -- Erectile dysfunction might be an early warning sign of blood vessel problems that can lead to heart attack or stroke, a new study finds.

The researchers found subtle problems in the arteries of men in their mid-40s who had erectile dysfunction but otherwise appeared to be healthy, says a report in the Jan. 21 issue of the Journal of the American College of Cardiology.

The finding has implications for the treatment of both erectile dysfunction and prevention of heart disease and stroke, says study leader Dr. Alan J. Bank, medical director of research at the St. Paul Heart Clinic in Minnesota.

"If they have erectile dysfunction, they should be treated more aggressively for high blood pressure, smoking and other risk factors for cardiovascular disease," Bank says. An added benefit is the drugs used for those risk factors might also improve sexual function.

Bank and his colleagues have started another study in which drugs such as statins, which reduce blood cholesterol levels, and ACE inhibitors, given for high blood pressure, can improve sexual performance of men with erectile dysfunction who have not responded well to Viagra, the first drug marketed for treatment of the problem.

"It will take a while to get results, but we are getting early indications that they might be effective," Bank says.

Some large epidemiological studies have pointed to a link between erectile dysfunction and cardiovascular conditions such as heart attack and stroke, Bank says. His study made a detailed examination of the brachial artery in the arms of 30 men with erectile dysfunction and a control group of 27 age-matched men without the problem. All were free of known risk factors for cardiovascular disease, such as high blood pressure, diabetes and smoking.

The arteries of men with erectile dysfunction had a worse response to measures to make them expand, such as nitroglycerine tablets. That failure to increase blood flow, a known factor in erectile dysfunction, can also affect arteries in the heart and other parts of the body, Bank explains.

"There is something abnormal about the smooth muscles in the artery walls," he says.

The finding "offers a lot of hope for improvement" for treatment of both cardiovascular disease and erectile dysfunction," Bank says. "We know a lot about blood vessel walls."

To provide a unified approach, a panel of five cardiovascular specialists and five urologists met last August and developed a set of guidelines about "how to approach erectile dysfunction -- what tests to do, how to handle the problem," Bank says. The guidelines have been submitted for publication in a medical journal.

"These results need confirmation and more explanation," says Dr. Melvin D. Cheitlin, professor emeritus of medicine at the University of California, San Francisco. Nevertheless, he says, "this is the first time as far as I can tell that someone is saying that people with erectile dysfunction may have problems with smooth muscle relaxation."

The "important message" of the study is that "erectile dysfunction can be a sign that an individual is at risk of arterial disease that can affect the coronary arteries," he says.

"A flagging penis should raise the red flag of warning to evaluate the patient for arterial disease elsewhere," Cheitlin concludes in the editorial.

More information

A description of erectile dysfunction and its treatment can be found at the National Institute of Diabetes & Digestive & Kidney Diseases or the Endocrine Society.

SOURCES: Alan J. Bank, M.D., medical director, research, St. Paul Heart Clinic, St. Paul, Minn.; Melvin D. Cheitlin, M.D., professor emeritus, medicine, University of California, San Francisco; Jan. 21, 2004, Journal of the American College of Cardiology

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