We’ve all seen the advertisements that show a good-looking, middle-aged man smiling from ear to ear because an erectile dysfunction (ED) drug saved his sex life.
What the ads don’t show, though, is that he may have a much more serious problem to worry about: a higher risk of heart disease.
A 2020 review published in the journal BJU International looked at seven studies and found that, compared with men without ED, those with the condition have a 45 percent higher risk of developing cardiovascular disease, a 50 percent higher risk of being diagnosed with coronary heart disease, and a 55 percent higher risk of having a heart attack. A 2021 review of 14 studies including over 90,000 men found that the risk of heart attack is even higher: 62 percent. ED ranks as high as having a family history of heart disease or being a smoker when it comes to heart disease risk.
Blood vessels explain the link
To get an erection, you need good blood flow into the corpora cavernosa, the spongy tissue inside the penis that fills with blood. Most cases of ED arise when narrowed blood vessels limit blood flow to the penis, called vascular ED.
One of the causes of narrowed blood vessels is a disorder called endothelial dysfunction, a type of coronary artery disease that decreases the amount of blood that can flow through arteries. It doesn’t affect only sexual performance: The same arterial narrowing occurs on the surface of the heart as well.
In some people, it can cause chest pain (or angina), but for many men, ED is the only symptom—one that serves as an important warning that the heart may be at risk. Researchers believe that endothelial dysfunction appears about five years before the onset of atherosclerosis—a condition in which plaques made of fats and cholesterol stick inside blood vessels. While both endothelial dysfunction and atherosclerosis narrow blood vessels, the latter can cause blockages, too, which can lead to heart attacks, heart failure, and ischemic stroke.
Take action now
The risk factors for ED, endothelial dysfunction, and atherosclerotic heart disease are all the same, so some basic lifestyle tweaks can lower your risk of all three:
- Stop smoking. Smoking is a major risk factor for both heart disease and ED.
- Drink alcohol only in moderation. Moderation for a man is no more than two drinks per day.
- Follow a Mediterranean-style diet. According to the American Heart Association (AHA), this diet features fruits, vegetables, whole grains, olive oil, and fish or poultry. It limits solid fats, red meat, processed foods, and sweets.
- Get enough exercise. The AHA recommends at least 150 minutes of moderate-intensity aerobic exercise every week, muscle-strengthening exercises on at least two days per week, and spending less time sitting. Getting up and moving instead of sitting, even for just five hours a week, improves cardiovascular health.
- Work with your doctor to lose weight if you are overweight.
- If you have high cholesterol, high blood pressure, or diabetes, work with your doctor to get these conditions under the best control possible.
Talk to your doctor
ED is not a normal part of aging, so if you begin to experience it—at any age—let your doctor know. He or she will want to rule out reversible causes of ED, such as depression, drug use, or low testosterone, and may look for diseases that cause ED, such as diabetes, multiple sclerosis, kidney disease, prostate disease, Parkinson’s disease, and Alzheimer’s disease.
If you still experience ED after you’ve made lifestyle changes, the usual next step is to take an ED medication like sildenafil (Viagra), avanafil (Stendra), tadalafil (Cialis), or vardenafil (Levitra). Common side effects include headache, facial flushing, nasal congestion, diarrhea, and backache. Sildenafil and tadalafil can induce temporary impaired color vision. These drugs can cause blood pressure to temporarily drop by five to eight points in healthy men, but in men who take nitrate drugs, such as nitroglycerin, they can lead to a dangerous reduction of 25 to 51 points and should be avoided. The FDA also urges caution for men with a history of congestive heart failure, unstable angina, low blood pressure, uncontrolled high blood pressure, or a history of stroke, heart attack, or serious disturbances of the heart’s pumping rhythm within six months.
Even if these drugs solve your ED, it’s still important to follow up with a cardiologist to monitor your heart health. ED is a serious red flag, and ignoring it can endanger much more than your intimacy.
