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The intimate link between impotence and heart disease

Atherosclerosis, or the narrowing of the arteries. (Tribune News Service)
Atherosclerosis, or the narrowing of the arteries. (Tribune News Service)
Howard Cohen Tribune News Service

Guys, pardon the frankness, but a couple failures in the bedroom on your end could actually be a lifesaver if you put aside the enormous male ego and take action.

Erectile dysfunction – the inability to get and keep an erection suitable for sex – can be an early warning sign of heart disease.

“Something like erectile dysfunction is a great avenue to get men into the clinic to see their primary care doctor so they can get screened for cardiovascular disease,” said Dr. Bernard Ashby, a Mount Sinai Medical Center cardiologist.

“A lot of time men don’t come in,” he said. “They don’t appreciate the implications of a poor lifestyle and are not seeing a doctor. Men don’t come into the doctor until something happens.”

Men, you know who you are.

Ashby gives an example of the common patient who overlooks certain things, like early heart failure and breathing problems, but when it’s related to sexual performance, well, attention perks up.

At least, there is good news in that respect.

“They won’t come into the hospital until they notice swelling in the testicles. They don’t think it’s a problem until something is wrong down there – some of the things we place a priority on. Any way we can get them to see us is a great way for us to get guys screened,” Ashby said.

The same process that creates heart disease may also lead to erectile dysfunction – only earlier, hence the importance to screen for a possible relation.

The inability of the arteries to dilate fully and to subsequently harden, through the buildup of plaques in the arteries of the body, can lead to stroke, heart attack and even sudden death. The process is called atherosclerosis, and the plaque buildup reduces the blood flow to the penis, rendering a male impotent.

But, as South Florida urologist Dr. George Suarez explains, the smallest arteries, not the heart but the arteries of the penis, which are very small, become blocked first. This shows up in the inability to become erect or to stay erect to engage in a satisfying sexual activity.

Erectile dysfunction preceding heart disease is a function of endothelium, or the dysfunction of the inner linings of the blood vessels and smooth muscle. Endothelial dysfunction leads to both poor blood flow to the heart and the penis and develops into atherosclerosis.

A report published in the Journal of the American College of Cardiology in 2008 detailed an Italian study of men with severe heart disease. Nearly all of the men, 93 percent, had erectile dysfunction two years before their heart attack or the onset of heart disease symptoms.

Impotence, however, doesn’t always indicate future heart problems.

“Every man is going to have a bad day, an off day, a tired day, a stressful day, a whatever day,” Suarez said.

He counsels concern if impotence is happening about 25 percent of the time. “One out of four, then you can say, ‘I have a problem.’ Obtaining means you’ve got enough blood flow to the penis to have an erection, maintaining means to keep the blood flow in there. More than 25 percent, it’s time to start looking for some solution.”

There are four things doctors and patients should then look at, he suggests.

– Is there an organic cause, which could be a history of high cholesterol, high blood pressure? Doctors can check the patient’s medications, if applicable, adjust them or prescribe treatment for the cholesterol and blood pressure issues and screen for heart disease.

– Is there a hormone deficiency, such as low testosterone? Simple test and fix, Suarez says.

– Are there neurological issues, any back issues, any nerve damage? Have you been injured? A physical exam could be telling.

– Is it all in your head? “Then we look for psychological issues and put that as the last thing we should look at,” Suarez says.

There are other risk factors for heart and erectile problems, too, such as diabetes, smoking, over consumption of alcohol, obesity and age.

However, age, when looking for the correlation between impotence and heart disease, is especially a concern for younger men under 50 who are at much higher risk for a link. In seniors 70 and over, erectile dysfunction is less likely to be a sign of heart disease.

Not that the senior set is idle.

“I see more elderly people that are sexually active in my practice than I did 20 years ago,” Suarez said. “I have a friend who owns a nursing home and he was telling me the other day that sexual activity in the nursing home is humongous.” Apparently, gone are the days of sitting on the porch, hand in hand, reflecting on memories. “Now these old people just want to screw all the time.”

Penile implants, generally a 30-minute outpatient procedure most often covered by insurance, and Viagra, at $40 a pop and not often covered by insurance, are some of the remedies for impotence – once endothelium and atherosclerosis are ruled out.

“If there is a plumbing problem because of atherosclerosis, there can be medical management or Viagra that can help increase blood flow,” Ashby said. “The more important issue is once there is evidence of atherosclerosis, heart disease, the chance of dying of heart attack increases exponentially. If we catch it at that point and know you are at higher risk, we need to be more aggressive in preventing a cardiovascular event.”

The message is to listen to your body and speak up when something isn’t right, even if it causes momentary embarrassment.

“A sense of intimacy has become a vital part of human nature in our society today and it is normal for a couple to seek that intimacy without fear and without shame and without performance anxiety. If there’s any chance or risk that is going to interfere with intimacy and that they can’t have sex, they should seek help,” Suarez said.

He added: “We work all of our lives to get to the golden years, and they are supposed to be golden.”

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