The term erectile dysfunction occurs when a man cannot achieve or maintain a firm enough erection for sexual intercourse. Though it isn’t something men like to talk about (unfortunately, even with their doctors sometimes), some degree of erectile dysfunction can affect many men after 40.
The rate of mild to moderate ED increases with approximately every decade of life after 40, affecting older men most frequently. This means that up to 50% of men in their 50s have some stage of ED, while that number increases to 60% of men in their 60s, and so on. Complete erectile dysfunction affects 5% to 15% of men between ages 40 and 70. The later stages of life are also when heart disease and other cardiac conditions tend to steadily rise among the aged population, which can complicate ED treatment. For these reasons, it’s essential to seek care and advice from knowledgeable providers who can help men keep their heart conditions in check, while also tending to their sexual health concerns, including ED.
Indeed, heart disease, kidney failure, brain stroke and ED all have a common root cause. This common enemy is the clogging of arteries, called atherosclerosis. Atherosclerosis can be caused by the high consumption of dietary fat, high cholesterol, diabetes and hypertension. Plaque build-up and clogging of the arteries leads to narrowing and decreased blood flow through these vessels, resulting in a malfunction of different organs. In the kidney, it causes renal failure. In the brain, it causes strokes and atrophy. In the heart, it can cause chest pain and heart attacks leading to a need for coronary artery stent placement. In the penis, it causes erectile dysfunction. In fact, in many men, the first sign of silent atherosclerotic heart disease or coronary artery disease of the heart is ED, rather than chest pain.
The common pathway leading to heart disease and ED is the clogging of small- to medium-sized arteries in the penis and the heart muscle (called coronary arteries). The muscles of the heart need excellent blood flow in order for the heart to pump and carry out its function properly. As the coronary arteries become clogged, there is decreased blood flow to the muscles of the heart, leading to heart disease — characterized as chest pain, heart attack or heart failure. Concurrently, in order to achieve and maintain a firm erection, the erectile bodies of the penis need to get filled with blood. As the arteries that supply blood to the erectile bodies become clogged, blood flow decreases, depriving the penis of much needed blood, leading to a failure to achieve a firm erection.
The most common, conventional ED treatments are oral therapies called PDE5 inhibitors. This class of medications works by relaxing blood vessels, thereby allowing more blood flow to certain parts of the body. PDE5 inhibitors include Sildenafil (brand name: Viagra) and Tadalafil (brand name: Cialis). However, some patients with coronary artery disease of the heart are not eligible to take these oral therapies. Patients with angina symptoms (cardiac-related chest pain on exertion) have clogged coronary arteries. These patients take a medication called Nitroglycerin. PDE-5 inhibitors may not be safe in patients on Nitroglycerin or those with angina, due to the higher risk of sustaining a heart attack.
For this potentially life-threatening reason, it’s critical that a patient who has known heart disease consults with their cardiologist before taking PDE5 inhibitors. Though not all forms of heart disease carry a contraindication for using a PDE5 inhibitor, it’s crucial to have an open and honest dialogue with each physician to ensure safety and efficacy.
While it may not be safe to take PDE5 medications if the man has coronary artery disease of the heart, other heart conditions allow for these therapies. In general, patients with hypertension, left heart hypertrophy, cardiac valve disease and mild congestive heart failure may be eligible for PDE5 therapy. Some men with advanced coronary disease will undergo stent placement. It’s essential to note that stent placement does not cause ED. Again, it’s the underlying arterial disease process that leads to the need for cardiac stent placement that also causes ED.
In patients who are ineligible for oral ED medication therapy due to heart conditions or other reasons, other treatments like intra-cavernosal injection, vacuum pump, intraurethral suppository or penile implants may be options to consider.
[Read: What to Know About Myocarditis]
While ED can be an initial sign of heart disease in some men, this isn’t always the case. That’s why it’s essential to have an honest conversation with a trusted physician regarding the symptoms experienced. Doing so helps chart the course for getting to the bottom of what’s going on and, ultimately, solving the problem.
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Erectile Dysfunction Treatment in Men With Cardiac Conditions originally appeared on usnews.com