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Researchers link male dysfunction, fatal heart disease

LOS ANGELES - For the first time, researchers have shown that erectile dysfunction is a strong predictor of the likelihood that men will die of heart disease.

Men who suffer from the problem, which some consider more an emotional than a physical issue, are twice as likely to succumb from cardiovascular disease or heart attacks as those without the problem, German researchers reported yesterday in Circulation: Journal of the American Heart Association.

Researchers have known for years that there is a link between erectile dysfunction, commonly abbreviated as ED, and heart disease, said Dr. Sahil Parikh, an interventional cardiologist from University Hospitals Case Medical Center in Cleveland, who was not involved in the study. "But now there is pretty clear evidence that there is a substantially increased risk of heart attack and death when patients have erectile dysfunction," he said.

The results are probably not too surprising, said Dr. Robert Kloner, cardiologist at the University of Southern California's Keck School of Medicine, "because arteries in the penis are smaller, so atherosclerosis shows up there sooner," perhaps three to four years before the onset of heart disease.

The take-home message, both experts said, is that when a patient seeks treatment for ED, typically from a general practitioner, he should be given a full physical work-up and be referred to a cardiologist. "When they are treated aggressively early, we can prevent heart attacks and stroke and they can have many years added to their lives," Parikh said.

Existing guidelines for treating men with ED from the Princeton Consensus Conference state that "a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise." Kloner, a co-author of those guidelines, said that when they are updated later this year, they will probably carry a stronger recommendation that patients with ED get a cardiovascular exam.

In the study, Dr. Michael Bohm, a cardiologist at Germany's University of Saarland, and his colleagues studied 1,519 men from 13 countries who were involved in a study of two drugs to treat cardiovascular disease.

A full 55 percent of the men had ED at the beginning of the trial, nearly double the normal incidence of about 30 percent in the population at large. In the five years of follow-up, men with ED were 1.9 times as likely to die of heart disease, twice as likely to have a heart attack, 1.2 times as likely to be hospitalized for heart failure and 1.1 times more likely to have a stroke. The risks increased with the severity of the ED.


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