by Janet Casperson, BS, MSN, ANP-C
What causes erectile dysfunction? What are the risk factors that can lead to problems. The concept of addressing cardiovascular risk factors in the field of urology and erectile dysfunction is relatively new but extremely important. The realization that the risk factors for cardiovascular disease are similar to the risks factors for erectile dysfunction has been amazing.
Age as a risk factor for ED
Probably the biggest risk factor that erectile dysfunction (actually, sexual dysfunction in general) and cardiovascular disease share is aging.
As men and women age, the blood flow to the sexual tissues such as the corporal bodies of the penis and the clitoris decreases. This decreased blood flow can lead to the lack of the ability to achieve and/or maintain an erection for men and indirectly to an inability for women to achieve orgasm.
The concept of aging and risks factors was well illustrated in the Massachusetts Male Aging Study, a study that was done in Boston in 1987-1989. This study looked at 1200 randomly selected men, from age 40 to 70, in the cities near Boston and detailed many aspects of their lives including levels of cholesterol, physiological measurements such as blood pressure, lifestyle, medications, smoking, heart disease, testosterone levels and erectile function. It was the first study that detailed the tremendous prevalence of erectile dysfunction in America. From this study, clinicians have gained a plethora of information about the aging process on men and how it relates to erectile dysfunction. This one study has been the catalyst for numerous subsequent studies on the aging process in men.
The findings of Massachusetts Male Aging Study were surprising. The study found that over 50% of men age 40 to 70 have a minimal, moderate or severe degree of erectile dysfunction. Age was the number one factor most strongly associated with erectile dysfunction. Findings also included a direct correlation between erectile dysfunction and heart disease, hypertension, diabetes, medications, depression, cholesterol levels, smoking, testosterone levels and personality characteristics. Table 2 compares the risk factors for cardiovascular disease and erectile dysfunction.
Cardiovascular and Erectile Dysfunction Risk Factors
|
Cardiovascular Disease
|
Erectile Dysfunction
|
|
Age
|
Age
|
|
Smoking
|
Smoking
|
|
Obesity
|
Obesity
|
|
Diabetes
|
Diabetes
|
|
High Cholesterol
|
High Cholesterol
|
|
High Blood Pressure (hypertension)
|
High Blood Pressure (hypertension)
|
|
Testosterone
|
|
|
Stress
|
|
|
Depression
|
|
|
Excessive Alcohol Intake
|
|
|
Medication (including herbals)
|
|
|
Prostate Disease
|
|
|
Relationship Problems
|
|
|
Neurological Disorders
|
The study provided an insight into the number of men who had erectile dysfunction; by extrapolation there were over 35 million men in America who had erectile dysfunction. This finding identified the large market for drugs like the PDE-5 inhibitors to treat erectile dysfunction.
In our own practice, the effects of aging and living are very well seen with our patient Bob T. who progressed slowly from mild to moderate to severe erectile dysfunction. His primary risk factor in addition to the failure of exercise and diet was his aging.
It's very important to highlight the fact that as men get older their erection can continue to diminish. However, this can be successfully treated. It's not uncommon in our practice to see many men well into their 80's who have very active sex lives and desire to keep it that way.
In conclusion, the relationship between cardiovascular disease and erectile dysfunction is well-documented by research. CVD and ED share many of the same risk factors, some of which can be modified. Remember, "if it is going to make your heart healthier, it is going to make your sex life healthier."
References: See Bibliography
Posted August 2008
Updated December 2011
