Erectile dysfunction is the recurrent or persistent inability to attain and/or maintain an erection in order for satisfactory sexual performance. It is present in up to 30 million men in the U.S. and approximately 100 million men worldwide. The U.S. has less than 8% of the world’s population, yet up to 30% of the impotence? We’re #1!
But hey, we’ve got red, white, and blue pills like Viagra. The problem is that the pills just cover up the symptoms of vascular disease and don’t do anything for the underlying pathology. Erectile dysfunction and our #1 killer, coronary artery disease, are just two manifestations of the same disease: inflamed, clogged, and crippled arteries, regardless of which organ it affects (See Survival of the Firmest: Erectile Dysfunction and Death).
Atherosclerosis is considered a systemic disorder that uniformly affects all major blood vessels in the body. Hardening of the arteries can lead to softening of the penis because stiffened arteries can’t relax, open wide, and let the blood flow. Thus erectile dysfunction may just be the flaccid “tip of an iceberg” in terms of a systemic disorder. For two-thirds of men showing up to emergency rooms for the first time with crushing chest pain, their penis had been trying to warn them for years that something was wrong with their circulation.
Why does it hit the penis first? Because the penile arteries in the penis are half the size of the coronary artery in our heart. So the amount of plaque we wouldn’t even feel in the heart could clog half the penile artery, causing symptomatic restriction in blood flow. That’s why erectile dysfunction has been called “penile angina.” In fact, by measuring blood flow in a man’s penis we can predict the results of his cardiac stress test with an accuracy of 80%. Male sexual function is like a penile stress test, a “window into the hearts of men.”
Forty percent of men over age forty have erectile dysfunction. 40 over 40. Men with erection difficulties in their 40s have a 50-fold increased risk of having a cardiac event (like sudden death). I said before that various things increase heart disease risk by 20% or 30%. That’s nearly 5000%, leading the latest review to ask, “is there any risk greater?” That’s because it’s not so much a risk factor for atherosclerosis as atherosclerosis itself. A man “with erectile dysfunction (even if he doesn’t have cardiac symptoms) should be considered a cardiac patient until proven otherwise.”
Erectile dysfunction is considered to be a cardiac equivalent; it’s a marker of the coronary artery one likely already has. Thus, there’s more to treating ED than establishing an erect penis; it offers an opportunity for reducing cardiovascular risk. The reason even young men should care about their cholesterol is because itpredicts erectile dysfunction later in life, which in turn predicts heart attacks, strokes, and a shortened lifespan.
May 20, 2014 by Michael Greger M.D.