A man with ED is a cardiac patient until proven otherwise

ED, which is defined as the inability of a male to achieve or maintain an erection sufficient for sexual intercourse, is a medical problem that can be very distressing for patients and partners alike. The risk of ED is related to many factors, including age, smoking, diabetes, heart disease, depression and hypertension - common risk factors of endothelial dysfunction and cardiovascular disease.

It has been known for some time that ED shares many risk factors with coronary heart disease, but new research shows that ED offers vital information about the possible risk of future cardiovascular events.

Studies, predominantly on diabetes patients, have been very beneficial in confirming this link - particularly as diabetes, ED and heart disease all share an ominous link - damage to the blood vessels.

One renowned study, the results of which were published last month, examined over 2 300 men with type 2 diabetes. At the beginning of the study, just over one quarter of the men had ED. None of the participants had any signs or history of heart disease, vascular disease or stroke. Follow up research on this same group of men four years later found that 123 of these men has suffered a heart attack, died from heart disease, developed chest pain caused by clogged arteries or needed bypass surgery or a catheter procedure to restore blood flow to the heart. Men who had ED at the beginning of the study were far more likely to develop one of these signs of coronary heart disease than the men who initially had no ED.

While the risk for ED and cardiovascular events is higher in men with diabetes, other studies have shown that this link is in no way only limited to men with diabetes. In fact, in certain studies abnormal cholesterol profiles were discovered in 60% of “healthy” men complaining of ED without a prior history of cardiac disease. Startling results from other studies conclude that 2% of the men with ED, who had no history of a cardiovascular (CV) event initially, would have such an event within one year of examination, and 11% would have a CV event within five years.

With these conclusions in mind, health care practitioners are being urged to be more forward thinking in talking about sexual performance in men. Men are often hesitant to discuss sexual problems with their doctors.

According to Dr Etienne Kok, a Sexologist and Andrologist from Pretoria, men visit their doctors less often for health related problems than women, which reduces the chance of disease recognition and treatment. This results in men receiving less preventative care, screening and tests.

Research has shown that GP-initiated discussion on ED appears to be uncommon. In a study, questions about ED were asked in only 17% of patients with hypertension, 18% of patients with diabetes and 30% of patients older than 65 years6. Furthermore only 27% of GP's reported asking all patients about ED at routine physical examinations. Reasons why enquiries about ED were not initiated included that the doctor lacked time and belief from the doctor that the patient would initiate discussions on this topic if required. Doctors also reported that questions concerning sex were not asked because they were unclear about what to do with the answer, fear of offending the patient and fear that these questions might be perceived as irrelevant.

What this research has shown is that questioning a patient about ED can no longer be feared to be irrelevant. Recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac patient until proven otherwise.

Erectile dysfunction has always been a matter of the heart - but this new research shows that far more than romance is at stake. ED can be a powerful early warning sign for serious heart disease, including heart attack and death.

“Many of your male patients may be reluctant to discuss sexual problems they may be having, but it is important that you routinely and sensitively ask about ED in patients as young as 40, since the condition is now known to be a possible warning sign of undetected vascular disease,” says Dr Thami Madlala, a Johannesburg urologist.

Up to 80% of cases of ED have an organic physical origin, and vascular disease is thought to be the most common cause.

“Acknowledgement of ED should prompt us as healthcare practitioners to be even more aggressive with our patients about lifestyle, diet and exercise modification needed to avoid future cardiovascular events, as well as to improve ED symptoms,” Dr Madlala says.

The good news for patients diagnosed with cardiovascular risk is that there is no evidence that treating ED or resuming sexual activity in patients with cardiovascular disease increases cardiac risk.

“This is provided that the patient is properly assessed and that the couple or individual is appropriately counseled,” says Dr Etienne Kok.

Oral drug therapy, such as PDE 5 inhibitors, are the most widely used because of their acceptability, safety and effectiveness.

There are currently three such treatments available in South Africa. One treatment has a duration of action of up to 36 hours. It is the only PDE5 inhibitor that can be taken without regard to food, with the rate and extent of absorption not affected by food and alcohol.

“All men with ED should undergo a full medical assessment. ED means Erectile Dysfunction but is also linked to Endothelial Dysfunction, Exercise and Diet, Early Detection and Early Death prevention,” summarises Dr Kok.

Issued on behalf of Lilly.