Erectile dysfunction is a strong predictor of coronary artery disease

That erectile dysfunction (ED) is a concern among the American populace can be easily discerned by watching almost any TV show for 20 minutes, during which time you will undoubtedly see a commercial offering to improve your sex life by means of a pill to combat ED. (Come to think of it, you don't even have to watch TV. Just check your e-mail.) But at least for some men, ED is about more than sex.

Over the past few years, several studies have shown that ED may be a sign of otherwise inapparent cardiovascular disease. In fact, some of those studies indicate the onset of ED can be as important a risk factor as the "traditional" risk factors, such as smoking, obesity, diabetes, high cholesterol or hypertension. These studies have also indicated that the prevalence of ED is strongly related to the presence of the typical risk factors for heart disease. That is, men had a much higher prevalence of ED if they were obese, hypertensive, diabetic or smokers. Nonetheless, even when these more traditional risk factors were accounted for, the presence of ED independently increased the risk of cardiovascular disease.

And more recently, investigators have reported that the age of a man at the time of onset of ED is an important consideration. The younger the man with ED, the higher the risk of cardiovascular disease. Specifically, the onset of ED in men under 60 (and most especially in men under 50) is a particularly strong predictor of a cardiovascular event during the ensuing 5 years. By age 70, however, the onset of ED is only a minor risk factor for cardiac disease. (By this metric, the youngish men with ED in the TV commercials had better see a doctor right away.)

These data strongly suggest that ED is often a vascular disease, probably caused by the same sort of process -- atherosclerosis -- that produces coronary artery disease. So the risk factors for coronary artery disease are the same as the risk factors for ED. This being the case, the onset of ED may indicate the presence of more generalized atherosclerosis, which would make cardiovascular disease affecting other organs more likely.

These facts have a couple of immediate implications. First, men who want to remain sexually active as they get older should live healthy lifestyles, and avoid the risk factors for coronary artery disease. In other words, the things men should do to prevent ED are the same things they should do to prevent heart disease. And second, docs should not just hand out the Viagra to men who have ED and tell them to go to town. They should do a full cardiovasculare evaluation, a complete assessment of cardiac risk, and advise the man with ED about aggressively reducing their risk factors.