Erectile dysfunction (ED) is defined as the inability for a man to attain and maintain an erection rigid enough for sex. Men can experience this problem at any age and for various reasons. As men age, the problem is most often due to poor blood flow, and this pattern is known as vasculogenic ED. Vasculogenic ED is often the very first sign of a change in cardiovascular health and precedes the onset of a significant cardiovascular event, such as a heart attack, by 3 to 5 years. When ED is present, this “canary in the coalmine” symptom gives men an important window of opportunity to address their cardiovascular risk factors and prevent serious health issues.

What is the link between erectile dysfunction and heart disease?

An erection happens when stimulation triggers nerve signals to the blood vessels in the penis. Cells that line the blood vessels, called endothelial cells, respond by producing nitric oxide. This causes the blood vessels to dilate and allow a sufficient amount of blood to flow into the penis to produce an erection. When the endothelial cells that line the arteries are damaged by factors like diabetes, hypertension, or smoking, the blood vessel loses its elasticity and blood flow is impaired. The result is a progressive decline in a man’s ability to attain and maintain a rigid erection. Endothelial dysfunction is also the first step in the buildup of cholesterol plaque in the coronary arteries and is the link between ED and cardiovascular disease.

Studies linking erectile dysfunction with cardiovascular risk show the strongest association with younger men in their 40s and 50s. These men may not have any symptoms like shortness of breath or chest pain when they exert themselves and may not think that they are at risk. Men presenting with ED should have an assessment of the common risks for cardiovascular disease like high blood pressure, elevated cholesterol levels, diabetes, and smoking. This information can be used to estimate their risk of a cardiovascular event, and if their risk is elevated, they should have additional testing. A test called a coronary artery calcium score can be performed to detect the buildup of cholesterol plaque in the blood vessels in the heart before it has progressed enough to cause symptoms. If cholesterol plaque is present, men can adopt healthy lifestyle changes to stop the progression of the problem. If the cholesterol plaque is extensive, men should be evaluated by a cardiologist and management may include the addition of medication like a statin or aspirin.

The association between erectile dysfunction and cardiovascular risk is also seen in men with diabetes and in men with pre-existing cardiovascular disease. These men should also be routinely screened for changes in sexual function.

Can erectile dysfunction and heart disease be prevented?

Like many other health conditions, simple lifestyle changes can be made to help decrease the risk of heart disease and related health concerns such as erectile dysfunction. These changes include:

Can I use erectile dysfunction medications if I have heart disease?

Men with cardiovascular disease are more likely to experience sexual dysfunction. While lifestyle changes are the foundation for treating heart disease and improving sexual health, some patients may need medications to assist with their erectile dysfunction. The good news is that medications commonly used to treat this condition are safe to use even after having a cardiovascular event. More recent studies suggest that medications for erectile dysfunction may even help to improve cardiovascular health and reduce risk for cardiovascular events. Men who are having symptoms, such as shortness of breath or chest pain, should always be evaluated before starting treatment for erectile dysfunction, and all men should check with their doctor about drug interactions before starting a new medication.

Talk with your doctor about your concerns

If you have noticed that you’re having difficulty attaining or sustaining an erection, contact your primary care physician to discuss your concerns. If your doctor recommends more specialized care, The Men’s Health Center at The Miriam Hospital can help.

The Men's Health Center

The Men's Health Center at The Miriam Hospital is dedicated to sexual health and andrology, and is the first center of its kind in the United States. The center provides expert care for issues with sexual performance, sexual dysfunction after prostate surgery, gender dysphoria, Klinefelter syndrome, and low sexual desire.