Erectile dysfunction could be a sign of early heart disease, says an Australian study. The study found that men with severe erection problems had nearly twice the risk of early death as men who had no erection problems. Men with erection problems also had higher risks of heart attack, heart failure and other heart-related problems. The study included data from 95,000 men. It is the largest study to look at the link between erection problems and heart disease. Erection problems are common. About 1 in 5 men over the age of 40 say they have moderate to severe problems maintaining an erection. The study was published January 29 in the journal PLoS Medicine. The Sydney Morning Herald newspaper, as well as several other newspapers, wrote about it January 30.

By Reena Pande, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Sexual problems may be a sign of problems with the heart. We now understand that sexual problems, like erectile dysfunction, can be sign of heart disease. Since as many as 30 million men in the United States alone report erectile dysfunction, and since heart disease remains the No. 1 killer in the United States, this is a major issue.

What is erectile dysfunction? It is when a man cannot have sex because he is unable to have or maintain an erection. There are many causes of erectile dysfunction, including:

• Problems with the blood vessels that supply blood to the penis (atherosclerosis) and risk factors for blood vessels problems (such as high blood pressure, high cholesterol, diabetes and smoking)
• Problems with the nerves that send signals to the penis (neuropathy)
• Low testosterone
• Prior pelvic or spine surgeries
• Certain medications
• Depression or anxiety
• Stress
• Drug and alcohol use

This week, in one of the largest studies on the topic so far, a group of researchers in Australia showed that erectile dysfunction is linked to higher risk of heart disease. They followed more than 95,000 men over age 45 as part of the "45 and Up Study" for several years. Participants reported if they had erectile dysfunction and the severity of their symptoms.

Here's what they found:

• Men who reported having erectile dysfunction had a higher risk of dying and a greater chance of needing to be in the hospital for a heart-related issue.
• The risk of heart disease was highest in those with the most severe erectile dysfunction.
• Even mild forms of erectile dysfunction carry risk of heart disease.

These findings are in line with several other research studies done over the last several years also showing a link between erectile dysfunction and heart disease risk.

Why exactly is erectile dysfunction linked to heart disease? One of the major causes of erectile dysfunction is problems with blockages in the blood vessels that supply blood to the penis. The same blockages that can develop here can also develop in the heart blood vessels. This is called coronary artery disease. Erectile dysfunction does not cause heart attacks. Instead, it serves as a sign of problems in the heart and higher risk of heart attack.

What changes can I make now?

We know that erectile dysfunction is a sensitive topic and not one that patients like to discuss freely with their doctors, or anyone for that matter. But this is a time to be silent no longer. So here are some reminders:

Talk about it. Trust me, we doctors have heard it all before. We understand that it's a sensitive topic, but we'd rather discuss it, think about ways to treat it, and think about ways to prevent heart disease risk. And try to mention it early in your appointment. Don't save it to the last minute when you are walking out the door! If you feel more comfortable, include it on a list of issues you write down to discuss with your doctor and hand the paper to your doctor when you arrive.

Know that you are not alone. Erectile dysfunction affects more than 1 in 3 men between the ages of 40 and 70. You are not alone.

Know that treatments exist. There are several treatments for erectile dysfunction.

Review your medication list with your doctor. Find out if one of your medications may be causing sexual problems.

Manage stress. Get treatment for anxiety or depression.

Consider a medication on an as-needed basis. Medications such as Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardanafil) work by increasing the blood supply to the penis. But remember, these medications cannot be used with certain heart medications called nitrates, such as nitroglycerin and isosorbide.

Reduce your risk of heart disease. There are many lifestyle changes that can help reduce the risk of heart disease:

• Quit smoking.
• Get regular exercise.
• Maintain a well-rounded, healthy diet.
• Maintain a healthy weight.
• If needed, get treatment for diabetes, high blood pressure or high cholesterol.

What can I expect looking to the future?

Having an early symptom like erectile dysfunction that signals increased risk can be very helpful to guide physicians and patients to earlier heart evaluation and more aggressive treatment of other risk factors for heart disease. This may also allow you to get an earlier start on medicines to improve erectile dysfunction and also lower heart disease risk. Expect more on this topic in the future. But don't wait to talk to your doctor about your symptoms.