Why does erectile dysfunction before 50 matter for the heart?
Erectile dysfunction can be an early warning sign of heart and blood vessel disease. In a study of 965 men without heart disease, younger men with erectile dysfunction, especially those under 50, had a higher Framingham cardiovascular risk score. Guidelines therefore treat erectile dysfunction as a risk marker that warrants a check of heart risk factors.
How is erectile dysfunction linked to heart disease?
Erectile dysfunction significantly increases the risk of heart and blood vessel disease, coronary heart disease, stroke, atrial fibrillation and death from heart disease or any cause. Men who seek treatment for sexual problems also have a high rate of heart and blood vessel disease.
"Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment." Source 2, p. 2
The European guideline treats erectile dysfunction as a precursor of heart and blood vessel disease, and more severe or longer-standing erectile dysfunction carries a greater risk. Erectile dysfunction is a risk marker, not a diagnosis of heart disease. It signals that heart risk is worth checking, and the checks above decide whether further investigation is needed.
Why does erectile dysfunction at a younger age matter?
The study behind the under-50 finding followed 965 men who had no heart or blood vessel disease. Younger men, especially those under 50, who had erectile dysfunction that came and went or persisted had an increased Framingham risk score, a standard estimate of future heart disease.
Erectile dysfunction is not limited to older men. Among men seeking help for new erectile dysfunction in one study, one in four was younger than 40, and almost half of these younger men had severe erectile dysfunction. Erectile dysfunction can also improve screening for heart disease that is not yet causing symptoms, in men with or without diabetes.
What checks are done for heart risk?
Both guidelines start with a medical history and a physical examination. The European guideline makes a strong recommendation to test blood glucose, blood fats and total testosterone, so that reversible risk factors can be found and treated, and the American guideline recommends measuring testosterone in the morning.
The heart assessment is based largely on a ten-year cardiovascular risk calculation that uses age, sex, ethnicity, cholesterol, blood pressure, diabetes and smoking. Because this tool can underestimate risk in men aged 40 to 60, an expert consensus recommends a coronary artery calcium scan for men whose result is borderline or intermediate. Heart medicines also matter for treatment. Using any form of nitrate is an absolute contraindication to PDE5 inhibitor tablets such as sildenafil, because the combination can cause a sudden drop in blood pressure.
Which changes help both erections and heart health?
Physical activity, particularly aerobic exercise, weight loss and treatment of heart risk factors may improve sexual function in men with erectile dysfunction, and statins have been shown to improve erectile function in meta-analyses. Conditions such as diabetes and high blood pressure should be well controlled as the first step of any treatment for erectile dysfunction.
The American guideline adds that changes in diet and more physical activity improve overall health and may improve erections. Starting these changes before, or at the same time as, treatment for erectile dysfunction is a strong recommendation in the European guideline.