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Is ED an Early Warning Sign For Heart Trouble?

Posted by: Men's Health Boston in Uncategorized on April 5, 2022

Let’s face it: a lot of people don’t think much about going to see their doctor until there is an urgent need. When things are going well, the theory for many is, “if it’s not broke, don’t fix it”. This presents a major catch-22 for preventive medicine. The goal is to get healthy people through the door, and to keep them that way; to catch problems early, when there is plenty of time to intervene. But from a patient’s viewpoint, if there isn’t a visible problem, there’s much less stimulus to get checked out.

The men who come to see us at Men’s Health Boston aren’t an exception to this rule. Whether suffering from low moods, chronic fatigue, or lack of libido, by the time they get to us, things have usually been off for a while. One of the biggest factors that finally brings them through the door? Erectile dysfunction.


We often underestimate how pervasive sexual dissatisfaction can be to our overall health, both physically and mentally. It erodes confidence and self-esteem and can cause tension and emotional distress in relationships. At MHB, we treat ED through a variety of methods, including testosterone replacement therapy (TRT), oral PDE-5 inhibitors (Viagra, Cialis), and Focused Sonic Wave Therapy. For men who undergo successful treatment, one of the most commonly reported results is a renewed sense of freedom and vitality.

But erectile dysfunction (ED) may also hint at a much deeper issue beyond sexual health. For some, it can serve as an early warning sign of heart troubles to come. And because researchers have associated ED with a two-fold increase in heart attacks and strokes – even in men without traditional heart disease risk factors– it also represents an opportunity for early intervention and preventive medicine. 

To better understand the link between ED and cardiovascular disease, we first need to follow both issues to their root causes.

How Do Erections Happen?

Erections result from the complex interplay between psychological stimulation and smooth muscle relaxation in the penis. It’s a process boosted by the effects of the powerful vasodilator nitric oxide (NO), which does exactly what its name suggests: it “dilates”, or relaxes, blood vessels to allow more blood to flow through them. 

When sexual stimulation (whether physical or psychological) occurs, neurotransmitters in the brain cause the release of NO, which relaxes the smooth muscle in the penis, widening the arteries and allowing blood to rush to the area. This extra blood fills the penile tissue as it expands to achieve an erection. As pressure builds in the penis, veins that normally act as an escape route get compressed, effectively trapping the blood to maintain an erection as long as the increased flow persists. 

In other words, the strength and duration of an erection depend upon strong blood flow in the arteries that circulate blood to the penis.

What Causes Erectile Dysfunction? 

Erectile Dysfunction occurs when something in this cascade of events doesn’t happen correctly, or to the extent needed to form a firm erection. Psychological or neurological factors could be at play, disrupting the signals from the brain necessary to tip the later dominoes. But in a large percentage of ED cases, the issue comes down to impaired blood flow in the penile arteries. Without adequate blood flow, there won’t be enough volume to fully expand the penis, or enough pressure to compress the venous escape route, and blood that rushes in won’t be adequately trapped. The result is a soft, partially formed erection that is much harder to maintain.

This is an important point to note because when impaired blood flow is to blame for ED, it can be an early warning sign of more problems to come. This is particularly true in people with a family history of cardiovascular disease (CVD) or additional cardiac risk factors. 

How Are ED and Heart Disease Related?

Cardiovascular disease (CVD), a more technical way of saying ‘heart disease’, describes a group of disorders affecting the health and functionality of the heart and blood vessels. The numerous problems under this umbrella share similar drivers, including chronic inflammation and the progressive build-up of plaque in the vessel wall known as atherosclerosis.  While education around atherosclerosis often emphasizes heart health specifically, when plaque builds up in the arterial walls, it doesn’t just happen around the heart; it happens peripherally as well. Similarly, the effects of chronic inflammation are seen in blood vessels systemically, reducing their capacity to properly relax and expand. This is why some experts consider ED and CVD to be two different clinical presentations of similar underlying problems.

ED and CVD 

The arteries that supply blood to the penis are only about half as wide as the arteries that supply blood to the heart. Because filling the penis requires a lot of blood to be diverted, these penile vessels also need a higher degree of vasodilation (or widening) to do their job and increase blood flow during an erection.

Because of this, it’s these smaller vessels that may actually be affected by plaque build-up and inadequate relaxation first, before the larger arteries around the heart. With a smaller overall area for blood flow, there may be a smaller margin for error before noticeable signs of a problem show up. Researchers feel that reduced blood flow might cause problems in the penis first for many men– which might explain why patients who are diagnosed with stable coronary artery disease (CAD or CCS) typically experience erectile dysfunction as much as 3 years before other symptoms.

It’s also telling that ED and CVD share many of the same risk factors. Among those most strongly correlated with ED are age, diabetes, hypertension, obesity, elevated cholesterol, and smoking – all major contributors to heart disease. Such a significant overlap means that one of the most effective ways to improve the health of your penis is to improve the health of your heart.

If I Have ED, Should I See a Cardiologist?

The answer here depends on a variety of factors. First and foremost, it’s important to get your ED assessed to determine the root cause. For patients suffering from ED due to challenging psychological factors, the imperative to get a cardiac evaluation might not be as high. But if your ED is related to impaired blood flow, your cardiac risk is elevated. Additionally, ED combined with another risk factor such as high blood pressure, high cholesterol, or obesity raises the stakes. A strong family history of heart attacks or heart disease may point toward genetic risk factors, which warrant further evaluation.

Not every man with ED will be at risk. But because ED precedes CVD in a large number of cases, it should be considered a serious warning flag. Its diagnosis provides a stimulus for deeper investigation and a window of opportunity for early intervention in men who are at-risk.

ED is frustrating enough on its own. Don’t risk a deeper issue. Don’t suffer in silence.

If you have ED and are concerned about your heart health, we can help. For more information on our world-class cardiology care at Men’s Health Boston, click here. For a clinical evaluation of ED and the associated risk factors, call our office to schedule an appointment with one of our providers.

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