IMPOTENCE
MAY WARN OF HEART DISEASE
Erectile dysfunction is defined as an inability to achieve or
maintain an erection.
"Erectile dysfunction could be called a 'penile stress test,'
and may be another way for detecting diseased blood vessels in
much the same way that the exercise stress test, which measures
electrical signals from the heart, is used to detect diseased blood
vessels of the heart," says Marc R. Pritzker, M.D., of the
Minneapolis Heart Institute Foundation.
"We now understand that atherosclerosis detected in one set
of blood vessels markedly increases the chances of having this
form of blood vessel disease in other areas of the body including
the heart, brain, legs and kidneys. Because the blood vessels that
supply the penis are narrower than arteries in other areas of the
body, atherosclerosis -- the disease process that leads to heart
attacks and strokes -- may manifest itself as erectile dysfunction
before the disease becomes apparent in other arteries. This provides
a wonderful opportunity for strong preventive programs that could
reduce the risk of heart attacks and strokes," Pritzker says.
Pritzker reviewed the histories and test results of 50 men with
erectile dysfunction who had sought prescriptions for Viagra (a
drug to treat impotence), and in turn were referred by their physicians
for further evaluation. Although none of the men had symptoms of
heart disease, 20 of them, or 40 percent, were found to have significant
blockages in heart arteries, which are associated with chest pain
and an increased risk of heart attack.
"Our population of patients was a very select
group. We do not wish to suggest that heart disease is behind
every case of
erectile dysfunction. However, a man having regular sexual activity
who experiences a consistent change in erectile function may be
demonstrating signs of atherosclerosis where arteries become clogged
and the heart muscle does not receive enough blood. As we become
more thorough in our questioning of patients, it is not uncommon
to hear that erectile dysfunction preceded the onset of heart disease
by a year or more. Thus erectile dysfunction may be an early warning
sign of the potential for heart problems."
Pritzker adds that anywhere from 30 to 50 percent of cases of
erectile dysfunction are the result of blood vessel disease. Other
possible causes include use of prescription drugs such as heart
or high blood pressure medications, pelvic injury, depression,
drug dependency, degenerative diseases such as multiple sclerosis,
and even fatigue and stress. Erectile dysfunction can also be the
result of psychological factors, he says.
"The experience to date with Viagra has shown it to be safe
for patients with most forms of cardiovascular disease when the
patients are appropriately counseled to avoid the use of nitroglycerin
or nitroglycerin-like drugs and follow reasonable guidelines regarding
physical exertion," Pritzker says.
"The introduction of new treatments for erectile dysfunction,
offered a options that were effective and easy. The openness that
followed has significant public health implications," says
Pritzker. "We now have another opportunity to look for heart
disease, make a diagnosis, and offer appropriate prevention and,
if necessary, treatment to men in an age group at risk for vascular
disease, but who often don't visit a physician for routine check-ups.
Only 15 of the 50 study participants had seen a physician within
the two years before seeking treatment for erectile dysfunction.
"The heart disease found in the study participants was treatable,
and in many cases the men's erectile dysfunction went away when
they quit smoking or got their cholesterol levels under control," he
says.
None of the patients in Pritzker's study had symptoms of heart
disease, but 40 out of 50 had at least one risk factor for heart
disease including cigarette smoking, elevated total cholesterol
levels, high blood pressure, diabetes or a family history of heart
disease. Treadmill exercise testing found signs of heart disease
in 28 of the 50 men.
Twenty of the men subsequently underwent angiography, where a
radioactive dye is injected into the heart arteries and then an
X-ray is taken in order to detect blockages. Six of the 20 had
blockages in all three major heart arteries, seven had two arteries
that showed narrowing, and one artery was blocked in the remaining
seven men. In the eight other men who had positive exercise tests,
further testing showed that either heart disease was not present
or that angiography was not warranted for the minimal heart disease
that was found.
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