Impotence may be early warning of heart disease

ATLANTA, Nov. 10 -- Erectile dysfunction may be an early warning sign of heart disease, according to research being presented today at the American Heart Association Scientific Sessions. Therefore, physicians should determine the cause of a man's erectile dysfunction and recommend additional evaluation in cases where it may be the result of diseased blood vessels, says the researcher.

Erectile dysfunction is defined as an inability to achieve or maintain an erection.

"Erectile dysfunction could be called a 'penile stress test,' and may be another way for detecting diseased blood vessels in much the same way that the exercise stress test, which measures electrical signals from the heart, is used to detect diseased blood vessels of the heart," says Marc R. Pritzker, M.D., of the Minneapolis Heart Institute Foundation.

"We now understand that atherosclerosis detected in one set of blood vessels markedly increases the chances of having this form of blood vessel disease in other areas of the body including the heart, brain, legs and kidneys. Because the blood vessels that supply the penis are narrower than arteries in other areas of the body, atherosclerosis -- the disease process that leads to heart attacks and strokes -- may manifest itself as erectile dysfunction before the disease becomes apparent in other arteries. This provides a wonderful opportunity for strong preventive programs that could reduce the risk of heart attacks and strokes," Pritzker says.

Pritzker reviewed the histories and test results of 50 men with erectile dysfunction who had sought prescriptions for Viagra (a drug to treat impotence), and in turn were referred by their physicians for further evaluation. Although none of the men had symptoms of heart disease, 20 of them, or 40 percent, were found to have significant blockages in heart arteries, which are associated with chest pain and an increased risk of heart attack.

"Our population of patients was a very select group. We do not wish to suggest that heart disease is behind every case of erectile dysfunction. However, a man having regular sexual activity who experiences a consistent change in erectile function may be demonstrating signs of atherosclerosis where arteries become clogged and the heart muscle does not receive enough blood. As we become more thorough in our questioning of patients, it is not uncommon to hear that erectile dysfunction preceded the onset of heart disease by a year or more. Thus erectile dysfunction may be an early warning sign of the potential for heart problems."

Pritzker adds that anywhere from 30 to 50 percent of cases of erectile dysfunction are the result of blood vessel disease. Other possible causes include use of prescription drugs such as heart or high blood pressure medications, pelvic injury, depression, drug dependency, degenerative diseases such as multiple sclerosis, and even fatigue and stress. Erectile dysfunction can also be the result of psychological factors, he says.

"The experience to date with Viagra has shown it to be safe for patients with most forms of cardiovascular disease when the patients are appropriately counseled to avoid the use of nitroglycerin or nitroglycerin-like drugs and follow reasonable guidelines regarding physical exertion," Pritzker says.

"The introduction of new treatments for erectile dysfunction, offered a options that were effective and easy. The openness that followed has significant public health implications," says Pritzker. "We now have another opportunity to look for heart disease, make a diagnosis, and offer appropriate prevention and, if necessary, treatment to men in an age group at risk for vascular disease, but who often don't visit a physician for routine check-ups. Only 15 of the 50 study participants had seen a physician within the two years before seeking treatment for erectile dysfunction.

"The heart disease found in the study participants was treatable, and in many cases the men's erectile dysfunction went away when they quit smoking or got their cholesterol levels under control," he says.

None of the patients in Pritzker's study had symptoms of heart disease, but 40 out of 50 had at least one risk factor for heart disease including cigarette smoking, elevated total cholesterol levels, high blood pressure, diabetes or a family history of heart disease. Treadmill exercise testing found signs of heart disease in 28 of the 50 men.

Twenty of the men subsequently underwent angiography, where a radioactive dye is injected into the heart arteries and then an X-ray is taken in order to detect blockages. Six of the 20 had blockages in all three major heart arteries, seven had two arteries that showed narrowing, and one artery was blocked in the remaining seven men. In the eight other men who had positive exercise tests, further testing showed that either heart disease was not present or that angiography was not warranted for the minimal heart disease that was found.