Erectile Dysfunction Precursor For Heart Disease

KUALA LUMPUR — Erectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men worldwide. This condition can be a precursor or an early warning sign of heart disease, say health experts.

UM Specialists Centre (UMSC) urologist Associate Prof Dr Ong Teng Aik said: “If a person has ED, he should not ignore it. It could signify a more serious problem involving not only the penis but also the heart or the brain.

“ED involves dysfunctional blood supply to the penis. For a man to have a hard erection, he needs an adequate blood supply to the penis.”

If a person’s blood vessel is affected, less blood is circulated to a specific organ, leading to problems for the organ concerned.

“So, with less blood flowing to the penis, he will get ED, and if there is not enough blood going to the coronary blood vessels in the heart, he may suffer a heart attack. And if there’s not enough blood going to the brain, he may get a stroke,” he told Bernama in an interview at UMSC recently.


The incidence of ED increases with age and is common in the older generation, said Dr Ong, citing an urban-rural scientific survey which he and his team conducted in Malaysia in 2008 involving 350 adults.

Seventy per cent of the respondents aged between 50 to 60 suffered from ED.

Of those with ED, 30 per cent were classified as mild and 20 per cent moderate while 15 to 20 per cent were in the severe category.

UMSC interventional cardiologist Dr Ramesh Singh Veriah said ED worsened with age and was closely linked with heart disease.

“One should not get confused between ED or impotence and libido or urge. A lot of people have the libido or urge for sexual intercourse, but they are unable to maintain sufficient erection,” he told Bernama during the joint interview.

He said most of his patients who were admitted after a heart attack would ask pertinent questions like what would happen to their lifestyle and their relationship with their wife, and whether they can be involved in sports. 


This prompted Dr Ramesh and his team to carry out a study in 2005 at the centre, the findings of which were presented in Washington in 2008.

Out of the 510 high-risk male patients, aged between 36 and 92 with established heart disease, surveyed, 90 per cent reported some degree of ED.

“Two-thirds of them actually reported that their ED was significant enough for them not to be able to have a proper (sex) life. Based on their history, the ED had started way before the heart attack,” said Dr Ramesh.

He said the sexual disorder did not directly affect the heart as it has many possible causes. Other causes to be considered include trauma to the spine, certain medications that could affect the younger age group and those there were psychological in nature.

Heart attack concerns blood vessels of the heart whereas stroke concerns blood vessels of the brain. All these blood vessels are small in size.

“Risk factors such as diabetes, high blood pressure, high cholesterol, smoking and obesity contribute to fat or plaque build-up in these vessels,” said Dr Ramesh.


Dr Ramesh said if the patient starts getting fat build-up in the blood vessels or what is termed as atherosclerosis, naturally, the perfusion of blood flow into organs such as the penis will diminish and the patient may suffer from erectile dysfunction.

Atherosclerosis is a generalised disorder that affects arteries in different organs at the same rate.

“But in the heart, sometimes you may not know it as it is slowly building up. What actually happens is that these patients end up having some form of symptoms later after many years of ED,” he added.

Dr Ramesh explained that when the blockages in the heart are very tight at 70 per cent or more, the patient may start feeling short of breath or experience chest pain.

“On an average, ED precedes heart disease by about three years. Many patients with borderline blockages often suffer sudden heart attacks and this may be prevented if we were able to screen those with pre-existing ED. While ED does not kill, a heart attack may,” he said.


Dr Ramesh also shared that if a patient has ED, the doctor would make him undergo a heart examination. Such a test, he noted, was easy to do and can be cost-effective, as well as prevent loss of life and loss of income from a heart attack.

“Once a patient gets a heart attack, he may suffer from heart failure. If he survives, not only is his personal life compromised, he may not be able to work and earn a living for his family. This can be devastating,” he added.

ED by itself does not cause heart disease. “The mechanism as to how ED comes about or how a heart attack or stroke comes about is atherosclerosis,” he stressed.

On whether ED is related to other diseases, Dr Ramesh said most patients have what is called multiple co-morbidities. They have a higher incidence of diabetes, hypertension and high cholesterol.

“We have found that after blood tests are done on those with ED, they may be newly diagnosed as having diabetes or high blood sugar levels which they may not be aware of.

“They are generally sicker or have the potential of becoming sicker than others. The onset of ED is a sign of poor health,” he said.


Said Dr Ong: “Many patients have been suffering for many years. They start having ED before they even know they have a heart problem. So if we can identify those patients, we can help them earlier. This is the main message.”

On whether ED affects younger people, he said the incidence is low as they do not have a manifestation of blood vessel disease such as atherosclerosis at an early age.

“The fact that (since) they are young, the disease will take some time to develop. They do get ED for other reasons such as psychological stress, depression and problems in their relationship with their spouse.

“But as they get older, there will be problems with blood vessels, diabetes, hypertension and high cholesterol,” Dr Ong added.


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