Cardiovascular disease is a very significant risk factor for erectile dysfunction (ED).
Almost 50% of men with known coronary artery disease proven by cardiac catheterisation have significant ED. Since the cavernosal arteries are smaller, they will tend to develop blockage from atherosclerotic plaques earlier resulting in vasculogenic ED years before the clinical appearance of coronary artery disease. Both cardiovascular disease and ED involve endothelial cell dysfunction in their pathophysiology. These patients will often demonstrate subclinical atherosclerosis long before any overt ED by as much as 10 years. Younger men who present with unexplained ED appear to have a very significant increase, up to fifty-fold, of their cardiovascular risk in later life compared to an age-matched control group. Patients should be informed that ED is a significant indicator of underlying heart disease, and they should be referred for further cardiovascular risk screening and treatment.
The Prostate Cancer Prevention Trial Database showed that having ED increased cardiovascular risk roughly equivalent to the risk of smoking or having a family history of myocardial infarctions. A meta-analysis totalling over 90 000 men with ED found that they had 44% more cardiovascular events, 62% more myocardial infarctions, 39% more strokes and a 25% increased risk of death compared to patients presenting without ED. If patients’ cardiovascular risk is intermediate, non-invasive testing for subclinical atherosclerosis and/or an exercise stress test is suggested, but if they are high risk, a formal cardiology referral is recommended.
Besides cardiovascular disease, there are strong correlations between ED, diabetes, hypogonadism, obesity, smoking, alcoholism, and benign prostatic hyperplasia (BPH) with lower urinary symptoms (LUTS).
- About 40% of men with ED will have hypertension while 35% of all hypertensive men will also have ED
- Hyperlipidaemia is found in about 42% of men with ED
- Obesity is associated with a 50% increase in ED compared to men of normal weight. However, one-third of the obese men with ED who enrolled in a weight loss programme resolved their ED problem in two years
- Heavy alcohol users also report an increased risk of ED compared to the general population
- There is a strong correlation between BPH with LUTS and ED. Up to 72% of men with symptomatic BPH will also have ED
- Patients with depression are almost 40% more likely to have ED than normal men without depression. Conversely, the incidence of depression in men with ED is almost three
- At least 30% of patients with ED will also have premature ejaculation and possibly as many as 60%. Successful treatment of the ED will often alleviate the premature ejaculation, due to reduced performance anxiety. If not, premature ejaculation can be alleviated much more easily once the ED has been successfully treated.
Sooriyamoorthy T, Leslie SW. Erectile Dysfunction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/