ED May Signal Heart and Vascular Problems

by Steven Abramowitz, MD, Vascular Surgeon, MedStar Heart & Vascular Institute
June 19, 2020

It’s a sensitive subject. For some, uncomfortable. Most guys don’t want to talk about it.

But most men will experience erectile dysfunction, or ED, at some point in their lifes—as many as 80 percent, by some estimates. Regardless of the cause, it’s always a good idea to talk to your doctor about it. It’s a common problem that’s often very treatable.

But staying silent can be dangerous, because this dysfunction may be a warning sign of cardiovascular disease. And a delay in reporting it might put your heart and blood vessels at risk.

When everything works normally, an intricate blend of psychology and physiology sends blood where it needs to go and keeps it there for a while. So, it makes perfect sense that trouble with an erection might be a sign of problems in the circulatory system, especially in men over 40.

Many long-term studies associate ED with both silent cardiovascular disease and silent peripheral vascular disease. It’s also been associated with disease in the aorta. Any disease that negatively impacts the smallest blood vessels—the microvasculature—can cause a host of problems, including stroke and heart attack. Because sexual performance is made possible by small blood vessels, dysfunction may serve as a warning of these potentially bigger problems.

Cardiovascular disease usually starts with damage to the endothelium, a thin layer that lines the blood vessels and vessels of the lymphatic system. In direct contact with blood, the endothelium controls blood flow and clotting. It plays a major role in regulating the immune system, combating inflammation and building new blood vessels. When the endothelium is damaged by factors such as tobacco exposure, several problems can occur—most typically, hypertension and poor circulation that can encourage life-threatening blood clots.

A Real Danger

Men who experience difficulty with an erection may be four times more likely to have cardiovascular disease and three times more likely to have carotid artery issues than men who have no difficulty. These risks are so well documented that, when erectile dysfunction is reported as part of a general workup, it often merits a cardiovascular assessment. That generally starts with a physician’s office visit and additional testing such as a stress test, EKG, or echocardiogram, depending on the individual. It’s important to identify any issues in the heart and blood vessels immediately, even before the ED itself is addressed.

Cardiovascular disease is just one potential cause. Sexual performance in men is complicated and depends on many things happening in the right sequence and at the right time. Sometimes, it’s psychological. Stress, in and out of the relationship, is a common culprit. Prescription and recreational drugs can interfere, including alcohol and tobacco. Diabetes, high blood pressure and high cholesterol play a role. Obesity is a potential cause. Low testosterone levels and other endocrine issues are contributors. Traumatic injury and some surgeries can affect it, as can problems in the brain and nervous system and even psychological trauma.

With all these potential causes, how do you figure out which one may be affecting you? Short answer: you can’t, on your own. That’s why it’s so important to talk to an expert.

Talking about erectile dysfunction could save your life—it’s a potential warning sign of cardiovascular disease. Details from Dr. Steven Abramowitz. https://bit.ly/2N9uC1c via @MedStarWHC
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Talking About It Could Save Your Life

Men experiencing performance issues should not avoid talking about it.

You could ignore it and hope for the best. You could try to treat it on your own. You could chalk it up to aging and forget about it. Or, you could do the right thing and talk to your doctor.

As a vascular surgeon, I can say without hesitation that delaying medical attention can lead to bigger issues in the future. If ED is caused by problems in the blood vessels, by the time that man comes to see me or a cardiologist, it could be too late. The damage has likely been done over years and, at that stage, there’s little any doctor can do to restore normal function. Before a patient gets to that point, there are dozens of ways we can help, including oral and injectable medications and devices to improve blood flow.

Unfortunately, the urge to keep the problem under wraps drives some men to self-medicate without a doctor’s visit. Erectile dysfunction is a big industry, with many players seeking a pathway to your wallet.

But you can also buy legitimate medications without visiting a doctor, and that’s really asking for trouble. You may try this for years before the pills stop working. Then what? If it turns out that your problems with an erection actually have cardiovascular roots, you’re much worse off than if you had sought medical attention earlier.

Don’t Go It Alone

ED can be more than a nuisance, embarrassment or source of anxiety for you and your partner. Although it can be uncomfortable to talk about, your healthcare provider can help you get the conversation started.

The issue can affect any man at any age and has many potential causes. Your doctor will work to narrow the cause, starting with a physical exam and medical history and asking key questions about your health and situation. It’s important to be honest in your answers—even the difficult ones, like any recreational drug history.

Expect questions about your general state of health and well-being. Weight, exercise and other lifestyle factors will be evaluated, as well as medication history, stress levels, relationship status, sleep patterns—things you might never consider without expert guidance.

Our multi-disciplinary approach includes urology, cardiology, vascular surgery and endocrinology, and a patient with erection issues may be referred to a specialist in one of these areas for testing. When our team has determined if the cause is psychological or physical, we can target the problem and devise a plan to improve the situation.

What You Can Do

Besides being candid with your doctor, anything that will improve your general health will also improve your blood flow, including regular exercise, good diet, avoiding tobacco and not drinking excessively. Because blood flow is key to performance, the better your cardiovascular health, the healthier your sex life can be.

In the final analysis, facing the issue is all benefit with no risk. Erectile dysfunction is more than just a physical problem. It can have a real impact on quality of life. It can make men anxious and can contribute to feelings of failure, inadequacy or letting their partner down. Those are all reasons enough to talk with your doctor.

But now you know: talking about it could also save your life and give you more years to enjoy it.

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Category: Healthy Living     Tags: cardiovascular-diseaseederectile-dysfunctionHv-2t