ED and coronary artery disease: Surprising bedfellows.(erectile dysfunction)(Disease/Disorder overview)

Men who develop erectile dysfunction (ED) often feel embarrassed, ashamed, and frustrated. The availability of good treatment and society's new openness have removed some of the stigma, but for many men, ED is still a heartbreaking affair. But if men a and their doctors a don't recognize ED as an important medical problem, the consequences may include a truly broken heart. That's because a man's ability to have an erection is often a barometer of his cardiovascular health.

Studies of men with ED

Not long ago, patients and their doctors called the problem "impotence" and viewed it as a psychological disorder. Now we know that only 15% of cases are caused by mental factors. Many now think of ED as a urological or endocrinological problem. It may be a but often it's much more. Even in men who have never had a twinge of chest pain, ED can mean a heart attack is in the wings.

A 2005 American study provides the best evidence. The subjects were 8,063 men ages 55 or older. When the study began in 1994, none of them had known coronary artery disease, but 3,816 (47%) had ED and another 2,420 (30%) developed the problem over the next five years. During eight years of careful observation, the men with ED were 1.5 times more likely to develop clinical manifestations of cardiovascular disease than were the men who had normal erectile function.

Other research agrees. Studies in 2003 and 2004 compared 12,825 men who had ED with an equal number with normal erections. After adjusting the results for the effects of age, smoking, obesity, and medication use, ED doubled a man's risk of heart attack, and it increased the risk of peripheral artery disease by 75%. A smaller but much more intensive …