Erectile dysfunction (ED) is defined as difficulty achieving or maintaining an erection.  ED affects approximately 18 million American men over age 20[1].  It is well known that many of the same risk factors that contribute to cardiovascular disease also play a role in erectile dysfunction.  A number of studies have shown that ED can predict cardiovascular disease[2] and cardiovascular mortality.[3] In my April 2009 newsletter, I reported on a 10 year study from the Mayo Clinic that attributed the strong association of ED with cardiovascular disease to them being “differing manifestations of a common underlying vascular pathology”.  In that study of 1402 male participants without known coronary artery disease, the men with ED had an 80% higher risk of developing coronary artery disease than those without ED.  And surprisingly, younger men with ED were at the highest risk.  The researchers concluded, “When ED occurs in a younger man, it is associated with a marked increase in the risk of future cardiac events, whereas in older men, ED appears to be of little prognostic importance. Young men with ED may be ideal candidates for cardiovascular risk factor screening and medical intervention.”[4]

New findings from the Massachusetts Male Aging Study confirm that ED may be a warning sign of a future cardiovascular event.[5] These results come from a collaborative study between New England Research Institutes, the Division of Cardiology, San Francisco General Hospital and the University of California, San Francisco which tested whether ED can be used to reclassify patients according to their future risk of developing cardiovascular disease beyond traditional risk factors (such as smoking, high blood pressure, high cholesterol, obesity, diabetes and physical inactivity).  After following 1507 men, aged 40-70, who had complete risk factor data available for more than 10 years, it was determined that ED predicted the development of cardiovascular disease (CVD) independent of age, traditional risk factors and Framingham risk score.   Men with ED had a 40% higher risk of developing cardiovascular disease than men without ED.

Looking at the Framingham risk score, which provides a 10-year estimated probability of a cardiovascular event, more than double the study participants with ED were in the highest risk category compared to men without ED.  In general, the men with ED were older than men without ED (59 years compared to 53 years), and had higher rates of smoking.  Men with ED also had higher body mass index, lower total and HDL cholesterol and higher blood pressure. All of the study participants were free of cardiovascular disease or diabetes at the start of the study.

Despite the statistical significance of the association between ED and CVD, in this study, ED was no better a predictor of CVD than traditional risk factors.  Although not improving the prediction of cardiovascular disease, the researchers reiterated that the results confirm the hypothesis that ED is a sentinel marker for cardiovascular disease, and these data should help put ED on the minds of physicians and patients.

Men with erectile dysfunction should be examined for testosterone deficiency and the metabolic syndrome, because these conditions commonly occur together.[6] Smokers are significantly more likely to experience ED than non-smokers; twice as likely in some studies.[7] Many risk factor can contribute to ED, including high blood pressure, diabetes, vascular disease, obesity, prescription medications, neurological diseases, depression, stress, physical injury, conflict with your partner and prolonged bicycling.

Other than reducing or eliminating any risk factor for ED, another solution may be found in a recent Finnish study: “Regular intercourse has an important role in preserving erectile function among elderly men…Continued sexual activity decreases the incidence of erectile dysfunction in direct proportion to coital frequency.”[8] Halleluiah!

[1] Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the U.S. Am J Med 2007;120:151–7.

[2] Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005;294:2996 –3002.

[3] Araujo AB, Travison TG, Ganz PA, et al. Erectile dysfunction and mortality. J Sex Med 2009;6:2445–54.

[4]Inman B, Sauver J, et al.  A Population-Based, Longitudinal Study of Erectile Dysfunction and Future Coronary Artery Disease. Mayo Clinic Proceedings February 2009 vol. 84 no. 2. 108-113

[5] Araujo A, Hall S, et al. Does Erectile Dysfunction Contribute to Cardiovascular Disease Risk Prediction Beyond the Framingham Risk Score?   J Am Coll Cardiol, 2010; 55:350-356

[6]Yassin A.  Low Testosterone May Cause Health Problems That Lead To Erectile Dysfunction.  The endocrine Society. June 2008

[7] He J. Erectile Dysfunction Linked To Smoking.  American Journal of Epidemiology. August 2007.

[8] Koskimäki et al. Regular Intercourse Protects Against Erectile Dysfunction: Tampere Aging Male Urologic Study. The American Journal of Medicine, 2008; 121 (7): 592