ED and Heart Disease: A Deadly Duo

If you already have erectile dysfunction, chances are you feel like you've got enough on your plate. But here's something else to worry about: you also run an increased risk of having a stroke or heart attack.

Studies show that erectile dysfunction (ED), a common condition, is primarily a vascular disease and may be a marker for hidden cardiovascular disease, according to research in the Journal of the American Medical Association. The researchers found that the risk of cardiovascular disease in men with ED was in the range of risk that's associated with smoking and with a family history of heart problems.

The bottom line? A diagnosis of ED should encourage the doctor to investigate possible cardiovascular risk factors. "In a man with ED, the risk of cardiovascular disease is about 65 percent higher than in someone without ED," says Daniel Silverstein, MD, staff physician at Patients Medical in New York City. A man with ED also has a higher than average risk of having a stroke, he says.

An erection doesn't just spontaneously happen: it requires blood to flow into the penis, which happens when the cells that line the arteries supplying blood to the penis release nitrous oxide. This causes a dilation, Silverstein explains. But when there is impairment to the cells, called endothelial cells, this doesn't happen.

That same impairment of the endothelial cells occurs in heart disease, which is why when there's ED, there also may be cardiovascular disease. An impairment of the blood vessels puts the man at an increased risk for atherosclerosis, and this can lead to heart attacks or strokes.

The risk factors for endothelial dysfunction include: obesity, high cholesterol, low testosterone, and smoking. Now that doctors know there are certain shared risk factors for heart disease and ED, they know to be watchful.

Men tend to pay a lot of attention to ED. But treating this and ignoring the possibility of heart disease can be a time bomb waiting to happen, explains Rashmi Gulati, MD, medical director of Patients Medical in New York City.  "A man may be trying to deal with ED without looking at his heart disease risk," she says, "But this can be a problem."

If you have ED, you should:

Get your blood pressure, blood sugar and blood cholesterol levels checked, says Silverstein.

Have a specific screening test for cardiovascular disease such as an EKG or a stress test.

Watch your meds. Some, like beta blockers for heart disease, can increase the risk for ED. Talk to your doctor about possible substitutions.

Now here's the good news: if your heart disease is treated and you lose weight, chances are you'll see your ED disappear, too. "About one third of patients are able to have normal erections after losing weight and being treated for heart disease," Silverstein says.


Thompson, Ian M., Tangen, Catherine M., Goodman, Phyllis J., Probstfield, Jeffrey L., Moinpour, Carol M., Coltman, Charles A., "Erectile Dysfunction and Subsequent Cardiovascular Disease." Journal of the American Medical Association. Vol. 294, No. 23, 21 December 2005.