Erectile Dysfunction Means Get a Cardiac Workup

Kathleen Blanchard's picture

Erectile dysfunction (ED) is linked to an overall risk of death, and double the chances of having a heart attack. Erectile dysfunction is closely associated with blood vessel disease, and a new warning suggests that men with ED should have a cardiac workup that can detect signs of atherosclerosis (hardening of the arteries).

The findings from German researchers, published in Circulation: Journal of the American Heart Association, found that erectile dysfunction also increases a man’s chances of having stroke and heart failure, and that ED is a strong predictor of death from all causes.

The study is the first to find that men with ED are twice as likely to die from all causes, have 1.9 times the chances of dying from heart disease - double the risk of heart attack and are 1.2 times more likely to be hospitalized for heart failure. For men with erectile dysfunction, stroke risk is 1.1 times more likely compared to men without ED; measuring the lifetime risks.

The findings come from a study of 1,519 men from 13 countries diagnosed with heart disease. The men were questioned about erectile dysfunction, and whether ED was mild, moderate, or severe, in a substudy of the ONTARGET and TRANSCEND trials of cardiovascular patients. Follow up was at 2 and five years.

Men with erectile dysfunction at baseline experienced higher death rates – 11.3 percent compared to 5.6 percent in men with no or mild reports of ED.


Michael Bohm, M.D., lead author of the study and chairman of internal medicine in the Department of Cardiology and Intensive Care at the University of Saarland, Germany says, “It is likely that the presence of ED identified individuals whose cardiovascular disease might be far more advanced than when evaluated with other clinical parameters alone.”

Men in the study with erectile dysfunction tended to be older, have high blood pressure, diabetes, stroke, or urinary tract surgery, contributing to erectile dysfunction, compared to those without ED. The participants in the ONTARGET study were randomly assigned ACE (angiotensin converting enzyme) inhibitor drugs alone or in combination. In the TRANSCEND trial, men who are intolerant to ACE inhibitors received either placebo or a blood pressure medicine called the ARB (angiotensin receptor blocker) telmisartan (Micardis).

Endothelial dysfunction that leads to inflammation, plaque buildup and heart disease is also linked to erectile dysfunction. Dr. Bohm suggests that men view erectile dysfunction the same as any other risk factor for heart disease that includes high cholesterol and hypertension.

“If a man has erectile dysfunction, then he needs to ask his physician to check for other risk factors of cardiovascular disease”, says Dr. Bohm. The link between erectile dysfunction and heart disease and increased risk of dying was found in 16.2 percent of men compared to 10.3 percent of men with either no or mild ED.

Erectile dysfunction is known to be an early sign of heart disease. Men who experience erectile dsyfunction should probably head to the cardiologist for a cardiac workup, and then to the urologist for a little blue pill.

doi: 10.1161/CIRCULATIONAHA.109.864199