|
Impotence Can Predict Coronary
Heart Disease
Impotence is more prevalent among men who have more severe coronary artery disease than among men with less severe forms of the disease, according to a report in the European Heart Journal.
And because impotence - erectile dysfunction (ED) - manifests itself two to three years sooner than coronary artery disease (CAD), the condition essentially serves as a "sentinel of the heart," or early warning system for cardiac trouble.
"It's an important message to get out," says Dr. Ira Sharlip, a spokesman for the American Urological Association.
"There's an increasing body of knowledge that tells us that erectile dysfunction is a form of cardiovascular disease and often predates the onset of other forms of clinical cardiovascular disease, specifically coronary disease," he says.
ED affects 52 percent of men ages 40 to 70 years in the US to some degree. The condition is linked with age, risk factors for atherosclerosis (hardening of the arteries), and heart disease.
Although in the past it was commonly believed to be due to psychological problems, it is now known that 80 percent to 90 percent of impotence is caused by physical problems, usually related to the blood supply of the penis.
Many advances have occurred in both diagnosis and treatment of ED.
ED and coronary artery disease share many of the same risk factors, including diabetes, smoking, high blood pressure, high cholesterol, obesity, depression, and lack of physical activity.
Among people with established coronary artery disease, the prevalence of erectile dysfunction may run as high as 75 percent, the researchers say.
For the study, the researchers evaluated the prevalence of ED and its relationship with coronary atherosclerosis in men with documented coronary artery disease.
They hypothesized that ED prevalence corresponds to the severity of heart disease.
The study involved 285 patients with coronary artery disease who were divided into four groups.
These groups included those with acute coronary syndrome and disease in one vessel; those with acute coronary syndrome and disease in two or three vessels; those with chronic coronary syndrome; and a control group of patients with suspected coronary artery disease but who were found by angiography to have normal coronary arteries.
Just over 22 percent of men who had coronary artery disease in one vessel had ED, compared to 55 percent of those with two-vessel disease, and nearly 65 percent in the group with chronic coronary syndrome.
Twenty-four percent of those in the control group had ED.
Despite the difference in prevalence between men with one- and two-vessel disease, these men had similar symptoms.
ED was associated with a four-fold increased risk of multi-vessel disease as opposed to single-vessel disease.
Ninety-three percent of men with both ED and coronary artery disease reported symptoms of ED one to three years before experiencing angina, with two years the average time.
Men with ED should be watched closely for coronary artery disease, the authors state. Others agree.
Dr. James M. Cummings, chief of the division of urology at Saint Louis University School of Medicine, says, "What is further significant is the growing body of literature linking the onset of erectile dysfunction to the symptomatic onset of coronary artery disease, thus giving clinicians a true window of opportunity to evaluate and prevent significant ischemic heart disease in a subgroup of men.
"It is more apparent than ever that men with onset of erectile dysfunction without already well-defined risk factors should probably have some type of cardiovascular evaluation," he adds.
"Men who have erectile dysfunction but no known coronary disease should be evaluated for occult coronary disease and should be counseled about lifestyle," says Dr. Sharlip.
"The most important point is that primary-care physicians need to learn to ask whether a patient has erectile dysfunction, because it can be an early sign of heart disease," explains Dr. Sharlip.
Always consult your physician for more information.
|
Impotence, or erectile dysfunction (ED), may result from the total inability to achieve erection, an inconsistent ability to achieve an erection, or the ability to only sustain a brief erection.
According to the National Institutes of Health (NIH), 15 million to 30 million men are affected by ED, depending on the definition used.
According to the American Urological Association, as men age, the level of circulating testosterone decreases, which may interfere with normal erection.
While a low testosterone level itself is rarely the cause of ED (5 percent or less), low testosterone can be an additional contributing factor in many men who have other risk factors for ED.
Other risk factors for ED include various medical problems such as hypertension (abnormally high blood pressure), diabetes, vascular disease, and high levels of blood cholesterol. Smoking and drug and alcohol abuse also are risk factors for ED.
According to the NIH, ED also is a symptom in many disorders and diseases.
Causes of ED are varied.
Premature ejaculation is the inability to maintain an erection long enough for mutual satisfaction. Premature ejaculation is divided into primary and secondary forms.
Performance anxiety is a form of psychological impotence, usually caused by stress or anxiety.
Depression is another cause of psychological impotence. Some antidepressant medications cause erectile failure.
Organic impotence involves the penile arteries, veins, or both, and is the most common cause of impotence, especially in older men. When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause.
The controllable risk factors for arteriosclerosis - being overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking - can cause erectile failure often before progressing to affect the heart.
Venous leak may be caused when the veins in the penis cannot prevent blood from leaving the penis during erection. This may be congenital or result from damage to the veins of the penis.
Impotence is common in persons with diabetes. There are 8.7 million adult men in the US with diabetes, and it is estimated that 35 percent to 50 percent of men with diabetes are impotent.
The process involves premature and unusually severe hardening of the arteries. Peripheral neuropathy, with involvement of the nerves controlling erections, is commonly seen in persons with diabetes.
There are many neurological (related to the nerves) causes of impotence. Diabetes, chronic alcoholism, multiple sclerosis, heavy metal poisoning, spinal cord and nerve injuries, and nerve damage from pelvic operations can cause ED.
A great variety of prescription medications, such as blood pressure medications, anti-anxiety and antidepressant medications, glaucoma eye drops, and cancer chemotherapy agents are just some of the many medications associated with impotence.
Hormonal abnormalities such as increased prolactin (a hormone produced by the anterior pituitary gland), steroid abuse by body-builders, too much or too little thyroid hormone, and hormones administered for prostate cancer may cause impotence.
Peyronie's disease is a rare inflammatory condition that causes scarring of erectile tissue that may result in curvature of the penis. This condition can impair sexual function.
Always consult your physician for more information. |