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Posted: June 03, 2008

When Erectile Problems Can Signal Heart Disease

More than sexual performance may be at stake for diabetic men with erectile dysfunction – it may be a serious warning sign for heart disease, including a risk of heart attack or death, according to two new international studies.

One of the studies also showed that cholesterol-lowering medications could cut the risk of heart problems by about a third and suggested that Viagra and other compounds in the same drug family might offer similar protection.


The research, which was published in the Journal of the American College of Cardiology, underscores the importance of encouraging all men to report erectile dysfunction (ED) to their physicians, and of focusing treatment not only on overcoming sexual dysfunction but also on improving overall cardiovascular health, the researchers wrote.


"The development of erectile dysfunction should alert both patients and healthcare providers to the future risk of coronary heart disease," said Peter Chun-Yip Tong, Ph.D., an associate professor in the Department of Medicine & Therapeutics at The Chinese University of Hong Kong. "Other risk factors such as poor blood glucose control, high blood pressure, high cholesterol levels, smoking and obesity should be reviewed and addressed aggressively."


Diabetes, erectile dysfunction and heart disease share an ominous link: damage to the blood vessels by high blood sugar levels. The same process that hinders the extra blood flow needed to maintain an erection can have even more serious consequences in the heart.


"The first event is probably endothelial dysfunction -- when the smoothness and reactivity of the blood vessel are damaged," said Tong. "This process encourages local inflammation on the inner surface of the blood vessels and the deposition of cholesterol, resulting in formation of clots and atherosclerosis. Therefore, there is a high risk of blockage of blood vessels in the heart, which can lead to a heart attack."


Medical experts say men typically show signs of ED more than three years before the onset of symptoms of coronary heart disease. In one study of diabetic men, symptoms of ED always preceded coronary symptoms.


In the Hong Kong-based study, Tong and colleagues set out to determine whether ED could be used as an early warning sign of poor cardiovascular health. Researchers recruited 2,306 men with type 2 diabetes, performing a medical evaluation of diabetic control and complications, including damage to the kidneys, eyes and cardiovascular system. At the beginning of the study, slightly more than 25% of the study participants had ED. None of the participants had any signs or history of heart disease, vascular disease or stroke.


The researchers followed-up the patients for an average of four years. During that time, 123 men suffered a heart attack, died from heart disease, developed chest pain caused by clogged arteries, or needed bypass surgery or a catheter procedure to restore blood flow to the heart. Men who had ED at the beginning of the study were far more likely to develop one of these signs of coronary heart disease -- or a "CHD event" -- than were men who initially did not have ED.


Statistical analysis showed that out of every 1,000 diabetic men with ED, 19.7 could be expected to experience a CHD event each year, as compared to only 9.5 of 1,000 diabetic men without ED.


The research team then performed an analysis that included many different characteristics that, like erectile dysfunction, were associated with the development of CHD, including age, high blood pressure, the need for cholesterol- or blood-pressure-lowering medications, the duration of diabetes, and damage to the kidneys or the eyes as a result of diabetes.


Even when these characteristics were taken into account, ED was found to be an independent early warning sign of coronary heart disease. In fact, ED signaled a 58% increase in the risk of CHD. Only the presence of large amounts of protein in the urine -- a sign of extensive kidney damage -- was a stronger warning sign, and this condition doubled the risk of heart disease.


The second study, conducted by researchers from four medical centers in Italy, focused on 291 men who not only had type 2 diabetes but also undiagnosed CHD, which they discovered by stress testing and confirmed by x-ray angiography. Of these, 118 had ED at the beginning of the study.


Lead investigator Dr. Carmine Gazzaruso and colleagues followed patients for nearly four years on average, documenting major adverse cardiac events (MACE), which they defined as not only CHD events but also stroke, mini-stroke (transient ischemic attacks) and arterial disease in the legs. They found that patients who had ED at the beginning of the study were twice as likely to suffer a major adverse cardiac event when compared to those without ED.


The study also showed that among patients who were taking cholesterol-lowering statins, the risk of a major cardiac event was reduced by one third. Viagra and other medications in a family known as 5-phosphodiesterase (5PDE) inhibitors also appeared to reduce the cardiac risk; however this finding was just beyond the borderline of what experts consider to be statically significant.


With respect to the Hong Kong study, Tong said that he and his colleagues are continuing to analyze a database of nearly 10,000 patients with diabetes in an attempt to answer several remaining questions about the link between ED, diabetes and heart disease, with findings to be detailed at a later date.

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