The Relationship Between Erectile Dysfunction and Cardiovascular Disease

1. 1. Definition of Erectile Dysfunction (ED)

      Erectile dysfunction or ED is a condition experienced by some men in which they are unable to get or keep an erection firm enough to achieve satisfactory sexual intercourse.

   2. Definition of Cardiovascular Disease (CVD)

      Cardiovascular diseases, in short, known as CVDs are a group of disorders of the heart and blood vessels. The risk of developing certain cardiovascular diseases increases by smoking, high cholesterol levels, high blood pressure, lack of exercise, unhealthy diet, and obesity.

   3. Purpose of the Article

      There is a certain kind of link associated between the two conditions, i.e. erectile dysfunction and cardiovascular disease. The purpose of this article is to understand the relationship between erectile dysfunction and cardiovascular disease. Read below to know about the association.

2. The Link Between Erectile Dysfunction and Cardiovascular Disease

   1. Mechanisms of Erectile Dysfunction and Cardiovascular Disease

      The mechanisms that could cause erectile dysfunction (ED) can be because of neurogenic, vasculogenic, hormonal, psychogenic, or pharmacogenic factors. It can also be due to alterations in nitric oxide/cyclic guanosine monophosphate (cGMP) or cyclic aminophosphate (cAMP) pathway or could also be due to other regulatory mechanisms like gap junction or ionic channel, which results in an imbalance in corporal smooth muscle contraction and relaxation.⁽¹⁾ The mechanism that causes heart disease and stroke, which are the major cardiovascular diseases includes high blood pressure since it can damage the lining of the arteries and thus make them more susceptible to plaque buildup, which ultimately leads to the narrowing of the arteries that lead to the heart and brain.

   2. Common Risk Factors for Erectile Dysfunction and Cardiovascular Disease

      Apart from sharing a common disease process, erectile dysfunction and cardiovascular disease also share many risk factors. The risk factors include hypertension, high level of cholesterol, diabetes, obesity, lack of physical exercise, poor diet, excessive consumption of alcohol, cigarette smoking, and psychological stress like depression.⁽²⁾ Apart from all these, age could also be a common risk factor for erectile dysfunction and cardiovascular diseases. As you grow older,

   3. Erectile Dysfunction As An Early Warning Sign For Cardiovascular Disease

      Erectile dysfunction or ED is common and it is as common as cardiovascular disease or CVD. Both these conditions frequently coexist.^{(3, 4)} Various epidemiological studies have shown a high incidence and prevalence of erectile dysfunction across the globe, affecting up to 150 million men.⁽⁵⁾ The problem behind this growing incidence of erectile dysfunction in men worldwide is that there might also be an increased risk of a growing incidence of cardiovascular diseases all over because erectile dysfunction could be linked with cardiovascular disease.

      Erectile dysfunction (ED) or the condition in which affected men are unable to get or keep an erection firm to have sex, can be an early sign of present or future heart problems. Similarly, if someone has heart disease, getting appropriate treatment at the earliest could help with erectile dysfunction.

      The idea behind this was that plaque buildup could reduce the flow of blood in the penis, and this could make an erection difficult. However, now it is believed that erectile dysfunction preceding heart problems could be due to the dysfunction of the endothelium or the inner lining of the blood vessels and smooth muscle. Dysfunction of the endothelium results in an inadequate supply of blood to the heart and also an impaired blood flow to the penis. This also causes the development of atherosclerosis.

      Erectile dysfunction is an independent and early harbinger of future cardiovascular diseases, thus providing an important alarm to initiate preventive measures for CVDs. So, proper and early screening and diagnosis of erectile dysfunction are required for the prevention of cardiovascular diseases (CVDs)

      NOTE: Erectile dysfunction (ED) does not always indicate an underlying heart problem. However, men with erectile dysfunction should be screened for heart disease along with taking their respective treatments.

3. Impact of Cardiovascular Disease on Erectile Dysfunction

   1. Physical Causes of Erectile Dysfunction in Individuals with Cardiovascular Disease

      Although Erectile dysfunction (ED) has multiple causes, which include low testosterone levels and also some medications, however, atherosclerosis is the most common cause. Cholesterol buildup in the walls of blood vessels slows down the blood flow, and to maintain an erection, extra blood flow to the penis is required.

      People usually think that atherosclerosis is generally associated with heart attacks, however, the condition also affects the blood vessels throughout the body, including those in the penis.

      An Australian study that included 95,000 men has shown that those with erectile dysfunction had more problems with cardiovascular issues, such as heart failure, stroke, and peripheral vascular disease, than men without erectile dysfunction (ED). It has been reported by the medical editor of a Special Health Report from Harvard Medical School says that erections are the barometer for overall health and erectile dysfunction is an early warning sign of trouble in the heart and other parts too.⁽⁶⁾

   2. The Psychological Impact of Cardiovascular Disease on Erectile Dysfunction

      Starting with feelings of sexual excitement, the brain plays a major role in triggering various physical events that lead to an erection. Several things can interfere with sexual feelings and can worsen or cause ED. Performance anxiety can be triggered by stress, guilt, and other stresses which can lead to more stress and problems with erectile dysfunction.

      When someone suffers from Cardiovascular diseases (CVDs) they might also deal with various types of stress, depression, and anxiety, and such things can interfere with sexual feelings and lead to erectile dysfunction.

      As per the National Institutes of Mental Health (NIMH), around 65% of patients with coronary heart disease having a history of heart attack experience different forms of depression.⁽⁷⁾

4. Medications Used to Treat Cardiovascular Disease and Their Impact on Erectile Dysfunction

   1. Medications To Treat Cardiovascular Disease

      Medications that are used to treat cardiovascular diseases (CVDs) are listed below.⁽⁸⁾

   2. Angiotensin-converting enzyme (ACE) inhibitors

      Angiotensin-converting enzymes or ACE inhibitors are responsible to expand blood vessels and allow an easy flow of blood. This in, turn, reduces the work load of your heart and makes it work more efficiently. Some ACE inhibitors are Captopril, Enalapril, Cilapril, Lisinopril, Perindopril, and Quinapril.

   3. Antiplatelet Medications

      Antiplatelet medications stop blood clots from forming and they do this by preventing blood platelets from sticking together. Aspirin, Dipyridamole, Clopidogrel, and Ticagrelor are some antiplatelet medicines.

   4. Anticoagulants

      Anticoagulants are also known as “blood thinners”. These medications work by interrupting the clot-forming process and by increasing the time it takes to form clots. This in, turn, aids in preventing the formation of blood clots and also restricting the existing blood clots from getting bigger. Some examples of anticoagulants include Heparin, Dabigatran, Rivaroxaban, Enoxaparin, and Warfarin.

   5. Angiotensin Receptor Blockers (ARBs)

      These medications expand your blood vessels and thus allow blood to flow more effectively, which reduces the workload of your heart and makes the heart work more efficiently.

      Angiotensin receptor blockers or ARBs are also known as “Sartans”. Some examples of ARBs are Candesartan, Losartan, and Irbesartan.

   6. Beta Blockers

      Beta-blockers are medications that decrease your heart rate. These medicines lower your blood pressure and make your heart beat with less force and more slowly. Some of these medicines are Atenolol, Carvedilol, Bisoprolol, Celiprolol, Labetalol, Propranolol, Metoprolol, Sotalol

   7. Medications For Erectile Dysfunction Caused Due To Cardiovascular Disease

      Some patients with CVD might have to undergo medical treatments that could include getting a heart stent. In such cases, the patients would have to take beta-blockers and one of the most common side effects of these medicines is sexual dysfunction. Erectile dysfunction caused due to beta-blockers is reversible when the medicine is stopped.

      Oral medicines like phosphodiesterase type 5 (PDE5) inhibitors include the first-line treatment for erectile dysfunction.⁽⁹⁾ Sildenafil (Viagra) and Tadalafil (Cialis) are the most common PDE5 inhibitors. Vardenafil HCL (Levitra) and Avanafil (Stendra) are other such medications. These PDE5 are the only oral medications that are approved in the USA by the FDA to treat erectile dysfunction.⁽¹⁰⁾

      If you are experiencing both ED and CVD then you should consult with your doctor about your best treatment options. Certain heart medications, particularly nitrates, are not safe to use if you are taking medications for treating erectile dysfunction.

5. Impact of Erectile Dysfunction and Cardiovascular Disease

   1. Effects of Erectile Dysfunction on Cardiovascular Health

      Men with erectile dysfunction or ED are also affected by cardiovascular disease (CDVs). So, ED has some sort of effect on cardiovascular health. In 2001, two reports have suggested that erectile dysfunction (ED) could be a marker for asymptomatic or silent coronary artery disease (CAD).^{(11, 12)} Subsequent reports have identified that erectile dysfunction preceded coronary artery disease in around two-thirds of cases.^{(13, 14, 15)} Moreover, the severity of erectile dysfunction correlates with the severity of coronary artery disease.⁽¹⁶⁾

      NOTE: Coronary artery disease can be included under Cardiovascular disease (CVD)

      A study conducted in 2013 has shown that erectile dysfunction (ED) is linked to heart disease and also early death in affected men, both with and also without any medical history of CVD.⁽¹⁷⁾ The study has shown that men with severe erectile dysfunction and also without known heart disease had a 35% increased risk of hospitalization for some or the other cardiovascular issues and a 93% higher chance of mortality than men with problems with erectile. Men who have experienced ED are at a greater risk of heart attack, stroke, or angina. Erectile dysfunction can act as an alarming sign of a more serious heart condition.

   2. Relationship Between Erectile Dysfunction and Cardiovascular Disease Prognosis

      In men with no cardiac symptoms, erectile dysfunction (ED), particularly in the case of younger men, is a marker of a significantly increased risk of cardiovascular disease or CVD. The treatment of erectile dysfunction should have a dual purpose, i.e. to restore sexual problems and also to prevent CVD events.

      There is a shred of growing evidence that erectile dysfunction is a sentinel marker of subclinical cardiovascular disease (CVD) and also precedes symptomatic coronary artery disease or CAD. Studies have shown an increased prevalence of erectile dysfunction in people with coronary artery disease when compared with men without CAD and also an increased risk of cardiovascular disease (CVD) in men with erectile dysfunction (ED) when compared with men without erectile dysfunction.^{(18, 19)}

      A retrospective study involving 62 men hospitalized for their first myocardial infarction (MI), found that 51.6% of them had pre-existing erectile dysfunction. ⁽²⁰⁾ It has been demonstrated that erectile dysfunction occurred on average three to five years before the cardiovascular event.⁽²¹⁾

      NOTE: It must not be practical to perform a systematic cardiologic screen on everyone suffering from erectile dysfunction.

6. Diagnosis and Treatment of Erectile Dysfunction in Individuals with Cardiovascular Disease

   In men with no symptoms of heart problems, Erectile dysfunction, particularly in younger men, is a marker of a potentially increased risk of cardiovascular disease. Treating erectile dysfunction should include two primary purpose, i.e. to restore sexual relations and to prevent the subsequent occurrence of cardiovascular diseases. Erectile dysfunction in men having known cardiovascular disease also identifies an increased risk. Erectile dysfunction is a cardiovascular equivalent that requires a prompt risk-reduction strategy for CVD, whether there is or is no known cardiovascular disease.^{(22, 23)}

7. Importance of Prompt and Accurate Diagnosis

   As erectile dysfunction and cardiovascular disease are linked, men with erectile dysfunction must undergo a proper medical or cardiological assessment. In the first instance, one should be sure of the erectile dysfunction diagnosis and from a cardiovascular perspective, the medical assessment must involve the measurement of blood pressure, glycosylated hemoglobin, fasting glucose, lipid profile, thyroid function, and also testosterone.^{(24, 25, 26)}

   The main question is whether in, men with erectile dysfunction, there is asymptomatic cardiovascular disease, particularly coronary artery disease, and also how to detect it. Pharmacology or stress testing on exercise will only identify lesions influencing the blood flow. Stress testing plays a crucial role in establishing the cardiovascular safety of sexual activity. Erectile dysfunction (ED) predicts acute coronary syndromes and all-cause mortality, which in the case of 60% of patients are not related to preceding cardiac symptoms.⁽²⁷⁾ It is thus essential to evaluate subclinical plaque, especially in the case of younger men who might be at intermediate risk of developing ED or any sort of CVD.⁽²⁸⁾

8. Treatment Options for Erectile Dysfunction in Individuals with Cardiovascular Disease

   1. PDE5 Inhibitors

      The first-line treatment for erectile dysfunction includes oral medications like phosphodiesterase type 5 (PDE5) inhibitors.⁽²⁹⁾ In the U.S. four PDE5 inhibitors, including Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil HCL (Levitra), and Avanafil (Stendra) are being approved by the Food and Drug Administration (FDA) for treating erectile dysfunction.⁽³⁰⁾ Usually, PDE5 inhibitors are safe to use in stable heart patients who are not taking nitroglycerin medicines and who are at least having average stability and fitness levels.

      However, PDE5 inhibitors should not be taken with nitroglycerin-based medication (nitrates), and using them together can cause hypotension and even lead to death. This has been cited in a 2018 research review.⁽³¹⁾

   2. Lifestyle Modifications

      Apart from taking these PDE5 inhibitors, lifestyle modifications are also required to treat ED, especially in people with CVDs.

   3. Using Penis Pump

      Using a penis pump, or a vacuum erectile device with a constricting ring is a pump that can be used for treating erectile dysfunction, since it helps you get and also maintain an erection. In most cases, penis pumps are safe and effective.

      Usually, doctors recommend a penis pump as a first-line treatment for erectile dysfunction (ED) for patients having heart or cardiovascular diseases.⁽³¹⁾

   4. Penile Implant

      This is the primary surgical treatment for erectile dysfunction. The most important benefit of this treatment is the ability to generate an erection for a long time and also as frequently as desired.

      Generally, a penile implant could be safe for erectile dysfunction in patients with heart disease.⁽³¹⁾

9. Importance of Addressing Both Conditions In A Holistic Manner

   It is important to address erectile dysfunction as well as cardiovascular disease holistically. Sometimes lifestyle changes, exercise, proper diet, sex therapy, couple counseling, and quitting smoking, and excessive alcohol, can be helpful in the treatment process of erectile dysfunction. Patients with erectile dysfunction should also undergo screening if they find any symptom that could be associated with CVD and get accurate treatment for ED and also CVD.

   Your GP can help in exploring various treatment options for improving sexual function and also significantly preventing life-threatening heart disease or CVD. One of the most important things to keep in mind is to have a better understanding of your risk factors and manage them with the assistance of your doctor, and doing this can help you in having a better heart (or/and erection) healthy life.

10. Conclusion

1. Recap of the Relationship Between Erectile Dysfunction and Cardiovascular Disease

   Studies have shown that there is a link associated between erectile dysfunction and cardiovascular disease. Many people with erectile dysfunction can suffer from cardiovascular disease and many times patients with CVD can also have difficulties in keeping erectile firm or having sexual satisfaction. Both ED and CVD share common risk factors and thus, knowing about one condition could easily help us in preventing the other.

2. Importance of Early Detection and Treatment

   If you have erectile dysfunction, you should not delay in going to our doctor and undergoing the early detection of any underlying condition that might co-exist with erectile dysfunction, including CVD. Once your condition is diagnosed early, it becomes easier to begin the treatment and help you prevent any danger, including death. Several treatments for erectile dysfunction can help and also are suitable for those living with heart problems.

3. Call to Action For Individuals with Cardiovascular Disease to address ED

   If you are experiencing erectile dysfunction or if you have been suffering from any sort of cardiovascular disease, you should fir consult with your doctor without delay. Addressing your condition is highly essential to prevent unwanted complications and dangers of the underlying conditions. You do not have to live with ED lifelong if you have CVD.

References:

Also Read:

• Viagra (Sildenafil) Treatment for Opioid Induced Erectile Dysfunction
• How Stress Causes Erectile Dysfunction & Treatment for Stress Induced Erectile Dysfunction
• How Common is Erectile Dysfunction?|Physical & Psychological Causes of ED
• What is the Best Medicine for Erectile Dysfunction?
• Ways to Make Erectile Dysfunction Meds Work Better
• Erectile Dysfunction: Causes, Treatment, How Common Is It, Can Young Men Suffer From Erectile Dysfunction
• Yoga For Erectile Dysfunction