Impotence
Can Predict Coronary Heart Disease
Impotence is more prevalent among men who have more severe
coronary artery disease than among men with less severe forms of the disease,
according to a report in the European Heart Journal.
And because impotence - erectile dysfunction (ED) - manifests
itself two to three years sooner than coronary artery disease (CAD), the condition
essentially serves as a "sentinel of the heart," or early warning system for
cardiac trouble.
"It's an important message to get out," says Dr. Ira Sharlip,
a spokesman for the American Urological Association.
"There's an increasing body of knowledge that tells us that
erectile dysfunction is a form of cardiovascular disease and often predates
the onset of other forms of clinical cardiovascular disease, specifically coronary
disease," he says.
ED affects 52 percent of men ages 40 to 70 years in the
US to some degree. The condition is linked with age, risk factors for atherosclerosis
(hardening of the arteries), and heart disease.
Although in the past it was commonly believed to be due
to psychological problems, it is now known that 80 percent to 90 percent of
impotence is caused by physical problems, usually related to the blood supply
of the penis.
Many advances have occurred in both diagnosis and treatment
of ED.
ED and coronary artery disease share many of the same risk
factors, including diabetes, smoking, high blood pressure, high cholesterol,
obesity, depression, and lack of physical activity.
Among people with established coronary artery disease, the
prevalence of erectile dysfunction may run as high as 75 percent, the researchers
say.
For the study, the researchers evaluated the prevalence
of ED and its relationship with coronary atherosclerosis in men with documented
coronary artery disease.
They hypothesized that ED prevalence corresponds to the
severity of heart disease.
The study involved 285 patients with coronary artery disease
who were divided into four groups.
These groups included those with acute coronary syndrome
and disease in one vessel; those with acute coronary syndrome and disease in
two or three vessels; those with chronic coronary syndrome; and a control group
of patients with suspected coronary artery disease but who were found by angiography
to have normal coronary arteries.
Just over 22 percent of men who had coronary artery disease
in one vessel had ED, compared to 55 percent of those with two-vessel disease,
and nearly 65 percent in the group with chronic coronary syndrome.
Twenty-four percent of those in the control group had ED.
Despite the difference in prevalence between men with one-
and two-vessel disease, these men had similar symptoms.
ED was associated with a four-fold increased risk of multi-vessel
disease as opposed to single-vessel disease.
Ninety-three percent of men with both ED and coronary artery
disease reported symptoms of ED one to three years before experiencing angina,
with two years the average time.
Men with ED should be watched closely for coronary artery
disease, the authors state. Others agree.
Dr. James M. Cummings, chief of the division of urology
at Saint Louis University School of Medicine, says, "What is further significant
is the growing body of literature linking the onset of erectile dysfunction
to the symptomatic onset of coronary artery disease, thus giving clinicians
a true window of opportunity to evaluate and prevent significant ischemic heart
disease in a subgroup of men.
"It is more apparent than ever that men with onset of erectile
dysfunction without already well-defined risk factors should probably have
some type of cardiovascular evaluation," he adds.
"Men who have erectile dysfunction but no known coronary
disease should be evaluated for occult coronary disease and should be counseled
about lifestyle," says Dr. Sharlip.
"The most important point is that primary-care physicians
need to learn to ask whether a patient has erectile dysfunction, because it
can be an early sign of heart disease," explains Dr. Sharlip.
Always consult your physician for more information.
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Impotence
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Impotence, or erectile dysfunction (ED), may result
from the total inability to achieve erection, an inconsistent ability to
achieve an erection, or the ability to only sustain a brief erection.
According to the National Institutes
of Health (NIH), 15 million to 30 million men are affected by
ED, depending on the definition used.
According to the American Urological
Association, as men age, the level of circulating testosterone
decreases, which may interfere with normal erection.
While a low testosterone level itself is rarely the
cause of ED (5 percent or less), low testosterone can be an additional
contributing factor in many men who have other risk factors for ED.
Other risk factors for ED include various medical problems
such as hypertension (abnormally high blood pressure), diabetes, vascular
disease, and high levels of blood cholesterol. Smoking and drug and alcohol
abuse also are risk factors for ED.
According to the NIH,
ED also is a symptom in many disorders and diseases.
Causes of ED are varied.
Premature ejaculation is the inability to maintain an
erection long enough for mutual satisfaction. Premature ejaculation is
divided into primary and secondary forms.
Performance anxiety is a form of psychological impotence,
usually caused by stress or anxiety.
Depression is another cause of psychological impotence.
Some antidepressant medications cause erectile failure.
Organic impotence involves the penile arteries, veins,
or both, and is the most common cause of impotence, especially in older
men. When the problem is arterial, it is usually caused by arteriosclerosis,
or hardening of the arteries, although trauma to the arteries may be the
cause.
The controllable risk factors for arteriosclerosis -
being overweight, lack of exercise, high cholesterol, high blood pressure,
and cigarette smoking - can cause erectile failure often before progressing
to affect the heart.
Venous leak may be caused when the veins in the penis
cannot prevent blood from leaving the penis during erection. This may be
congenital or result from damage to the veins of the penis.
Impotence is common in persons with diabetes. There
are 8.7 million adult men in the US with diabetes, and it is estimated
that 35 percent to 50 percent of men with diabetes are impotent.
The process involves premature and unusually severe
hardening of the arteries. Peripheral neuropathy, with involvement of the
nerves controlling erections, is commonly seen in persons with diabetes.
There are many neurological (related to the nerves)
causes of impotence. Diabetes, chronic alcoholism, multiple sclerosis,
heavy metal poisoning, spinal cord and nerve injuries, and nerve damage
from pelvic operations can cause ED.
A great variety of prescription medications, such as
blood pressure medications, anti-anxiety and antidepressant medications,
glaucoma eye drops, and cancer chemotherapy agents are just some of the
many medications associated with impotence.
Hormonal abnormalities such as increased prolactin (a
hormone produced by the anterior pituitary gland), steroid abuse by body-builders,
too much or too little thyroid hormone, and hormones administered for prostate
cancer may cause impotence.
Peyronie's disease is a rare inflammatory condition
that causes scarring of erectile tissue that may result in curvature of
the penis. This condition can impair sexual function.
Always consult your physician for more information. |
