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Writer's pictureSaneka Chakravarty, MD, FACC

Erectile dysfunction is often the first sign of underlying heart and vascular problems

Updated: Oct 4


couple lying in bed, awake, facing away from each other

Erectile dysfunction can have a significant impact on the quality of life, not only for the individual experiencing it but also for their partner. A strong link exists between ED, depression, and anxiety, which can create a cycle of worsening symptoms.

Regrettably, many men choose not to seek treatment for this condition.

Two comprehensive studies revealed that erectile dysfunction is prevalent in 30-52% of men aged 40-79 years.

Interestingly, higher rates of erectile dysfunction were observed in the United States, Eastern and Southeastern Asian countries compared to Europe or South America. The exact reasons for this variation remain unclear.

In the interest of transparency, while 1 in 4 men under 40 seek medical assistance for ED, there is a scarcity of studies in this age group. This might partly stem from the notion of a higher prevalence of psychogenic and temporary causes of ED in this demographic, although this isn't an excuse to disregard it.

You might be wondering about the causes of erectile dysfunction, which can indeed be intricate and multifaceted.

It could be psychogenic, arising from stress, depression, anxiety, or relationship issues, or it could have a physical cause, referred to as organic ED.

Organic ED may stem from neurological factors (nerve damage), vascular issues (related to heart, blood vessels, and metabolism), or pelvic injuries/surgeries. Hormonal causes have also been suggested, although this remains a topic of debate.

The most common cause of organic ED is related to heart and vascular factors.

Surprisingly, three major analyses have linked ED as an early indicator of heart disease and a predictor of future silent cardiac events.

Alcohol consumption and smoking habits consistently affect erectile function. A clear dose-response relationship has been observed between smoking and ED, with prolonged and increased smoking correlating with a higher likelihood of ED. Quitting smoking can partially or fully reverse this effect. Similarly, alcohol abuse can have a comparable impact, although moderate alcohol consumption may not be as detrimental.

Data suggests that a Western diet may be less favorable compared to a Mediterranean diet. Engaging in regular moderate physical activity has been shown to reduce the risk of ED.

Obesity, particularly central obesity, is a significant and independent risk factor for ED.

Diabetes, even at the prediabetes stage, can negatively impact sexual health.

The odds of ED increase threefold with high blood pressure, 2.57-fold with diabetes, 1.8-fold with high or abnormal cholesterol, and 1.4-fold with smoking.

It's worth noting that while high blood pressure isn't directly responsible for ED, changes in blood vessels mediated by high blood pressure can contribute to the condition.

Thankfully, a range of safe treatment options for ED are available today.

However, it's essential to prioritize lifestyle changes and risk factor modification alongside any treatment to address the root cause of the issue.

Here are our recommendations:

For younger men (between 40 and 55) experiencing ED, comprehensive cardiac evaluation is crucial, as this can often signal underlying heart problems. This is especially important if there are no existing medical conditions like high blood pressure, diabetes, or heart disease. This evaluation is as significant as providing symptomatic relief for ED.

Promptly introducing lifestyle changes alongside treatment is essential to address the core issue. This includes engaging in at least 30 minutes of moderate physical activity most days, shedding excess weight if overweight, and transitioning from a Western diet to a Mediterranean one.

Quitting smoking and moderating alcohol consumption are essential steps.

Addressing any existing depression or anxiety is equally important.

Information sourced from: "Erectile dysfunction" by Faysal Yafi et al, Nature Reviews Disease Primers.

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