Erectile Dysfunction May Be More Than A Sex Problem

March 16, 2010— -- Among patients with heart problems, those with erectile dysfunction, or ED, are far more likely to suffer heart attacks or die from heart problems in the near future, a new study suggests.

The research, released Monday, took a look at more than 1,500 men who received treatment for heart disease over a roughly four-year period.

The findings did not bode well for those who experienced erectile problems along with their heart issues. The researchers found that treatment for heart disease did little to help erectile dysfunction in men with this problem. But more troubling was the finding that men who experienced both erectile dysfunction and heart problems were twice as likely to die over the course of the study than those who had heart problems alone. The men with erectile dysfunction also faced a doubled risk of heart attack.

"I think we need to bear in mind that if somebody has erectile dysfunction, we really need to treat them," said Dr. Koon Teo, a professor in the department of medicine at McMaster University in Hamilton, Ontario, Canada, and one of the researchers on the study.

But the study further indicates that, when faced with men who have erectile dysfunction, doctors should not simply write them a prescription for a pill like Viagra or Cialis and send them back out the door.

"The medication works and the patient doesn't show up anymore," said Dr. Michael Bohm, the chief cardiologist at the University of the Saarland in Germany and the primary investigator for the study, in a statement. "These men are being treated for the ED, but not for the underlying cardiovascular disease. A whole segment of men is being placed at risk."

Other researchers said the study adds to a growing body of literature suggesting that erectile dysfunction may be a warning flag for a larger problem.

"This study adds greatly to what we know about ED and mortality risk, which is relatively little at this point," said Andre Araujo, director of epidemiology for the New England Research Institute.

Erectile Dysfunction Should Be Discussed

"This is a very well-conducted study, and the conclusion that ED is a strong predictor of death from all causes and other events in men with CVD is well-justified," said Araujo.

Teo said the research also gives a message to doctors and their male patients.

"Erectile dysfunction is something that people don't want to talk about," Teo said. "It needs to be talked about ... and [doctors must] raise the red flag that if they haven't had the [heart risk factors] looked at carefully then they need to be looked at, and, if necessary, treated."

A Smaller Sign of a Larger Problem

While the study, published in the journal Circulation, may have provided further evidence of the meaning of ED for a patient, experts had some questions about how much can be drawn from the findings.

Clinton Webb, the department chair in physiology at the Medical College of Georgia who has received an NIH grant to study erectile dysfunction, said the researchers should have done more to determine the nature of ED the patients had.

He said knowing how long the patients had erectile dysfunction might have helped in interpreting the paper, as the problem can worsen with time, especially since patients were not given ED treatments as part of the study.

"The longer you have the erectile dysfunction, the more [unresponsive] the tissue becomes," Webb said.

While patients in the study were given drugs for their heart, researchers did not see any improvement in erectile function among patients whose heart problems were being treated, a finding Webb and Araujo both noted was surprising.

But, Webb said, "The really strong point in the paper is that [erectile dysfunction] is a predictor of cardiovascular death."

With the growing body of literature on dangers ED might represent, urologists have taken notice.

"Obviously you take a lot of other factors into consideration," said Dr. Tom Lue, vice chair of urology at the University of California, San Francisco, noting that in a 25-year-old patient, the problem of erectile dysfunction is almost certainly psychological. Older patients, however, should see a cardiologist as well.

"It's another blood vessel," Lue said of the penis. He advises older patients with erectile dysfunction to have another look for potential problems. "We are not just treating the penis, we are treating the patient."