Younger Men with Erectile Dysfunction Twice as Likely to Develop Heart Disease

New research from the Mayo Clinic indicates that “men who experience erectile dysfunction between the ages of 40 and 49 are twice as likely to develop heart disease than men without dysfunction.”

According to a Mayo Clinic news release, investigators in 1996 identified a cohort of 1,402 men who did not have heart disease and assessed their urological and sexual health every two years for the next 10 years. The researchers used subjects’ answers to the Brief Male Sexual Function Inventory questionnaire to determine erectile dysfunction. Baseline prevalence of erectile dysfunction was 2.4% in men age 40—49 years, 5.6% in men age 50–59, 17% in men age 60–69, and 38.8 % in men age 70 years and older.

Over 10 years of follow-up, researchers found that men with erectile dysfunction were 80% more likely to develop coronary heart disease compared with men without erectile dysfunction. They reported that “the highest risk of new heart disease was seen in the youngest study participants who had erectile dysfunction. In men 40 to 49 years old when the study began, the number of new cases in men with erectile dysfunction was more than 50-fold higher than in men without erectile dysfunction.”

The researchers also reported that in men in their 50s, 60s and 70s, “the total incidence of new cases of heart disease also was higher in those with erectile dysfunction. However, the differences were not as striking as those seen among the 40- to 49-year- olds.”

Although this study did not investigate the causes of the increased risk of heart disease, the authors, writing in the February 2009 issue of Mayo Clinic Proceedings, suggested that the presence of erectile dysfunction in men prior to the onset of heart disease “may be partially explained by blood vessel size.” They noted that, given the smaller diameter of penile arteries compared with coronary and carotid arteries, “an atherosclerotic plaque of a given size should occlude and hemodynamically affect a penile artery earlier than a coronary or carotid artery.” This would hold true if slow and progressive vascular occlusion were the underlying cause of both [erectile dysfunction] and [coronary artery disease], which, the authors note, is not always true. Indeed, they also point to endothelial dysfunction as another possible signal event, noting that “many patients with [erectile dysfunction] exhibit evidence of inflammation and endothelial dysfunction independent of their [coronary artery disease] status.”

The authors stated that their data suggest that erectile dysfunction in young men may possibly be “an early manifestation of a progressive systemic vasculopathy, preceding the development of coronary disease by decades. The long temporal association between [erectile dysfunction] and new cardiac events is important to underscore because it implies that studies must be designed with prolonged follow-up if any systemic sequelae of [erectile dysfunction] are to be found. Furthermore, the timing of events raises the possibility of a window of curability, whereby the progression of cardiac disease might be slowed or halted by some form of medical intervention.”

Click here to read the full text of the study.

Additional Resources:

In an editorial titled “Erectile Dysfunction and the ‘Window of Curability’: A Harbinger of Cardiovascular Events” that appeared in the same issue of Mayo Clinic Proceedings, Martin M. Miner, MD, from the Men's Health Center at Miriam Hospital in Providence, RI, wrote “The meaning of these findings is important. Although ED and CAD may be different manifestations of an underlying vascular pathology, when ED occurs in a younger man (<60 years), it is associated with a marked increase in the risk of future cardiac events, whereas in older men it has less prognostic value. The importance of the study by Inman et al cannot be overstated.”

Click here to watch a video of one of the study authors, Jennifer St. Sauver, PhD, explaining why this study was undertaken. Download an mp3 file here.

Click here to watch a video of St. Sauver reviewing key findings from the study. Download an mp3 file here.

Click here to watch a video of St. Sauver explaining what the study results mean for patients. Download an mp3 file here.

specialty: cardiology