Erectile Dysfunction and your Heart

Over the last decade it has been consistently demonstrated that there is a direct cause and effect relationship between cardiovascular disease (CVD) and erectile dysfunction (ED).

Dr. Evan Goldfischer of Premier’s Urology Division, makes a point of telling his ED patients, “the penis is a barometer of cardiovascular health.”

“The arteries to your brain, the carotid arteries, are fairly good sized,” Goldfischer explains.” The arteries that supply your heart are medium sized, but the artery to your penis is very small. If you’ve got cholesterol plaques and cardiovascular disease resulting in blood not flowing adequately to the organs, the one that gets clogged first is the smallest one, the one that supplies the penis,” he says. “This is manifested by erectile dysfunction. If the plaques build up some more, a man could end up with a heart attack or a stroke.”

ED drugs provide an early clue  “If you go all the way back to the early 90s, you’ll find that Viagra was originally developed as a vasodilator, a medicine to treat heart failure and hypertension. When the drug went into clinical trials, it was discovered that it had a side effect, it gave men erections,” says Goldfischer. Today, both Viagra and Cialis are marketed, under different names, for pulmonary hypertension. “It should tell you something,” Goldfischer notes, “that these ED drugs are, at their core, vascular drugs.”

Starting around 2005, it became commonplace in the urological literature to look at ED as a marker of cardiovascular disease. Soon after, the ED-CVD link began to be examined in the cardiology literature. “About two years ago, we had a “journal club” with Hudson Valley Heart Center,” Goldfischer says. “ We presented five articles from our literature and they presented five articles from their literature, and we quickly realized just how close these papers were… the cardiologists and the urologists were drawing the same conclusions.”

The two disciplines decided to create some synergy. The urologists recognized that patients coming in with erectile dysfunction—for example, the average 55-60 year old man with diabetes or hypertension whose erections had been getting weaker over the years—is likely to have some degree of vascular disease. “When they come in for ED, and their patient history fits the profile, we’ve been advising them to see a cardiologist, if they don’t already have one, for a cardiovascular workup,” says Goldfischer. Similarly, the cardiologists are now asking their patients whether or not they can get a satisfactory erection.

Vascular, hormonal or both? It can be a complicated situation. “We now know that 20%, or more, of all diabetics have low testosterone, it’s just something that happens with the disease,” says Goldfischer. “We typically see men with a number of confounding variables: for example, a patient may be a diabetic, he may have some peripheral vascular disease and some cardiovascular disease, as well as the problem of not having erections that brought him to us. The question is, is it a vascular problem, a hormonal problem, or is it both? The cardiologists have taken a bit more aggressive stance than they used to and they’re asking their patients about these things. It’s been a very good collaboration with the cardiologists and has resulted in our patients getting better care.”