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For men, the first danger signs of heart disease may show up below their belts. A man's sexual health can tell a lot about his risk for some major illnesses, a McGill University study has found.
Erectile dysfunction - a topic of conversation that makes even the most brawny chaps squeamish - is linked to an increased risk of heart disease, stroke and diabetes. "Erectile dysfunction is an early warning system for the health of the vascular system," says Steven Grover, a specialist in cardiovascular health at the McGill University Health Centre.
Grover and his colleagues studied a group of 3,912 Canadian men, ranging from 40 to 88 years old. Almost half of the men reported having experienced erectile dysfunction in the four weeks prior to visiting their family physicians. The doctors measured the levels of cholesterol and glucose in the participants' blood, and recorded their blood pressure and the medications they were taking.
The study was one of three on erectile dysfunction published in the current issue of the Archives of Internal Medicine. Erectile dysfunction is the inability to get or keep an erection. The penis consists of spongy tissue that is fed by many tiny blood vessels. Anything that keeps blood from flowing to the penis, such as narrowing or constriction of the blood vessels (atherosclerosis) or high blood pressure, can lead to erectile difficulties. Some medications can also cause erectile dysfunction.
"We knew that erectile dysfunction was commonly associated with cigarette smoking and diabetes, and people who had heart disease; we didn't have a lot of data on how important it is in the risk of developing cardiovascular disease," says Grover.
The men who said they had erectile difficulties were more likely to have the risk factors associated with vascular disease. Grover, who is cross-appointed between the department of medicine and of epidemiology and biostatistics, plugged the information into a series of mathematical models that predict the risk of developing heart disease.
Age and diabetes share strong links to erectile dysfunction. "Diabetes increases the odds of having erectile dysfunction about three-fold, even after you've adjusted for age, the presence of medications, the presence of cardiovascular disease and cigarette smoking," notes Grover.
Maintaining a healthy lifestyle has benefits beyond reducing the risk of developing cardiovascular disease, diabetes, or cognitive decline and dementia. Good habits also reduce the risk of developing erectile dysfunction.
"By not smoking, keeping weight under control, exercising regularly, keeping blood pressure, cholesterol and blood sugar under control, it looks like you can also reduce the risk of erectile dysfunction, as well as reducing the risk of heart disease and dementia," says Grover.
Although studies suggest that erectile dysfunction is common, many men are reluctant to discuss it with their doctors. Doctors may also be uncomfortable raising the topic with their patients. But with the variety of treatments now available, more men are seeking help.
"Patients might say they don't want to bring up the issue of sexual difficulties, but this is an additional impetus to say, well, maybe it is a good thing to get checked out," says Grover.
"It tells physicians and patients that maybe they should be looking for modifiable risk factors for heart disease as well," says Grover. "Physicians should be measuring cholesterol, checking blood pressure, and seeing whether there are early signs of hyperglycemia or diabetes."
The Canadian study supports another published in the Journal of the American Medical Association in December 2005. That study showed that men aged 55 and over with erectile dysfunction were more likely to experience chest pain, a heart attack or a stroke over the next seven years.
"More and more work was pointing in the direction that erectile dysfunction was just an early manifestation of atherosclerosis," says Grover. "The penis is linked to all these other organ systems, and it may be the first to go."