Wall Street Journal
February 20, 2007

When Bill Bozick first started having problems with erectile function in his 50s, his doctors thought the problem was a side effect of pain medications. It wasn't until he suffered a heart attack that doctors realized his erection problems had likely been an early warning sign of heart disease.

"It never occurred to me it could be heart disease and my doctor never suggested it," says Mr. Bozick, now 63 and a retired quality-assurance manager in Stow, Ohio.

There's a growing push in the medical community to treat a man's erectile function as an important indicator of overall health rather than just a lifestyle problem. Some studies show that erectile dysfunction, or ED, may be one of the earliest warning signs of heart disease, giving men as much as three years' notice before more serious symptoms show up. And early research shows that the same things a man can do to boost his heart health -- such as weight loss, exercise and lowering cholesterol -- can also lead to better erections.

"The penis is a barometer of the health of the vascular system," says Andrew McCullough, director of male sexual health and fertility at New York University School of Medicine. "But unfortunately you're fighting this stigma of minimizing the condition."

The reason erectile function is so closely linked with heart and vascular health is that the penis is sustained by two main arteries. If a man has vascular disease that causes narrowing of the arteries or plaque buildup, the damage often shows up first in the small penile arteries rather than the larger arteries leading to his heart. This month, the American Journal of Medicine reported that ED is particularly common among men with one or more cardiovascular risk factors, such as high blood pressure, and strongly associated with lack of exercise.

The good news is that ED may be an early enough warning sign that men have time to help their hearts. An Italian study showed that in two-thirds of patients with both heart disease and ED, the erection problems showed up, on average, three years before other more obvious symptoms, such as chest pain.

ED PROBLEMS

Here are some risk factors:

• Heart disease, diabetes, hypertension and low testosterone boost risk

• Surgery/trauma damage nerves that control erections

• Antidepressants, antihistamines, pain and blood-pressure drugs interfere

• Stress, anxiety, depression and alcohol affect function

Source: Mayoclinic.com

Doctors say it's important for men to know that every man who suffers from ED isn't necessarily headed for a heart attack. Nearly every man, as he ages, will suffer some loss of erectile function, meaning he needs more stimulation for an erection or won't be able to achieve a second one as quickly. ED is diagnosed when a man regularly fails to obtain or maintain an erection sufficient for intercourse.

Unfortunately, there's no consensus on what additional heart tests a man with ED should undergo. Options include a test for C-reactive protein, an indicator of heart-attack risk, or a coronary-artery calcium test -- which uses imaging to measure calcium buildup in the arteries. Another option is to perform a test using an injection that triggers an erection. If that test fails, there's a greater chance that vascular disease will have progressed enough to show up on an exercise stress test for the heart. Another strategy is to follow up with men after prescribing an ED drug such as Viagra, Cialis or Levitra. Men who aren't helped by the drugs may be at higher risk for heart troubles and a vascular study of the penile arteries might be recommended.

The good news is there is some early evidence that taking steps to improve cardiovascular risk factors, such as lowering cholesterol, can boost erectile health. Last March, the Journal of Sexual Medicine reported on a pilot study of 12 men with high cholesterol whose erection problems weren't helped by Viagra. After six weeks on the drug Lipitor, the men's cholesterol levels dropped by an average of 43%, and their average erectile function scores with Viagra nearly doubled.

"Many men's lifestyles are so unhealthy in terms of lack of exercise and terrible diet," says Drogo K. Montague, head of prosthetic surgery at the Cleveland Clinic's Urologic Institute. "Basically what is a heart-healthy lifestyle is also good for erections."