Dr Margaret answers emailers’ embarrassing problems
in this monthly problem page.

Impotence and cardiovascular disease

Dear Dr Margaret
I have difficulty with erections. I read in a magazine that this means I could have a heart attack. Is that true?

It is true that there is a link between erection problems (also called erectile dysfunction or impotence) and heart disease, for the following reason. For an erection, you need good blood flow into the penis through its arteries. A common cause of erection problems is that these arteries have become clogged or damaged. (There are many other possible reasons – see look at the section on erection problems.) If the arteries in the penis are clogged or damaged, it is likely that other arteries in the body are in the same state. This includes the coronary arteries, which supply the heart muscle with oxygen and nutrition. If the coronary arteries become furred up, angina or a heart attack may occur.

Therefore erection problems can be the first sign that your coronary arteries are not as healthy as they should be and that you have an increased risk of a heart attack. This link between erection problems and coronary heart disease has been known for many years, and has been confirmed by some recent studies. For example, researchers in the USA studied 3,816 men who had erection problems, and compared them with 4,247 men who had no erection difficulty. The study lasted 7 years. During that time the men who reported erectile dysfunction at the start of the study had a 45% increased risk of a cardiovascular event, such as a heart attack, compared with the men without any erection difficulties.

If you tell your doctor that you have erection problems, he or she will recognize this as a warning and will check your cardiovascular system. This will include a blood pressure check and measurement of the lipids in your blood, such as cholesterol. Your blood sugar should also be measured, because diabetes is another risk factor for clogged arteries. Your doctor can then advise you on how to keep your arteries as healthy as possible. If you are a smoker, you must definitely stop – look at www.quit.org.uk for help. You should lose weight if you are obese and, if your blood lipids are raised, your doctor will prescribe a statin medication.

Sources of information
Thompson IM, Tangen CM, Goodman PJ et al. Erectile dysfunction and subsequent cardiovascular disease. Journal of the American Medical Association 2005;294:2996–3002.

Grover SA, Lowensteyn I, Kaouache M et al. The prevalence of erectile dysfunction in the primary care setting. Importance of risk factors for diabetes and vascular disease. Archives of Internal Medicine 2006;166:213–9.

Min JK, Williams KA, Okwuosa GW. Prediction of coronary heart disease by erectile dysfunction in men referred for nuclear stress testing. Archives of Internal Medicine 2006;166:201–6.