Can treating erectile dysfunction really prevent cardiovascular disease?

Author: Li Dongjie, deputy chief physician, Xiangya Hospital, Central South University, postdoctoral fellow in medicine, young member of the Science Popularization Branch of the Chinese Medical Association, young member of the Andrology Branch of the Chinese Medical Association, science popularization China expert

Reviewer: Li Hongjun, Professor of Peking Union Medical College Hospital

Since the reform and opening up, my country's economy has flourished, and people's living standards have also improved. Cardiovascular disease, a "rich disease", has also entered the homes of ordinary people and has long replaced cancer as the "number one killer" in my country. It has exceeded the sum of all cancer-related causes of death. This "number one killer" is closely related to a common disease in men, which is erectile dysfunction. Erectile dysfunction, also known as impotence, has a particularly high incidence rate. It not only affects the patient himself, but also his spouse.

1. The relationship between erectile dysfunction and cardiovascular disease

What is still seldom known is that erectile dysfunction is like a sentinel, usually acting as a forerunner event earlier than cardiovascular disease. European scholars believe that vascular erectile dysfunction usually occurs 2 to 5 years earlier than cardiovascular disease patients. Bad habits such as smoking, alcoholism, and staying up late are common high-risk factors for cardiovascular disease and erectile dysfunction.

Figure 1 Copyright image, no permission to reprint

Timely and effective treatment of erectile dysfunction can improve the prognosis of cardiovascular disease. Swedish scholars followed up 88,000 patients with myocardial infarction for 7 years and found that the mortality rate of patients who received timely and standardized treatment for erectile dysfunction decreased by 33% and the risk of hospitalization for heart failure decreased by 40% [1]. The main reason for this is that erectile dysfunction and cardiovascular disease share common high-risk factors, such as smoking, aging, hypertension, diabetes, overweight, dyslipidemia, and sedentary habits. The two also have common pathological mechanisms, such as endothelial damage. The blood vessels at all levels of the human body are like large and small rivers. If a small river is completely blocked by silt, the large river may still flow. The blood vessels in the penis are thinner and more prone to problems; while the coronary arteries that supply blood to the heart are much thicker, so it is common for elderly people to have no symptoms, but upon examination, it is found that the coronary arteries are 70% blocked. Erectile dysfunction plays an important early warning role in cardiovascular disease.

Erectile dysfunction has the same pathology as cardiovascular and cerebrovascular diseases. Symptoms usually first appear in the penile arteries, which have a smaller inner diameter, which is erectile dysfunction.

Our previous etiological study on 3,327 patients with erectile dysfunction in five large tertiary hospitals in my country also found that coronary heart disease is closely related to erectile dysfunction [2]. The risk of coronary heart disease in people with erectile dysfunction is increased by more than 3 times. We also found that staying up late is one of the common causes of both.

2. Middle-aged and elderly men should actively treat erectile dysfunction

Erectile dysfunction is a common disease among men over 40 years old, but Chinese middle-aged and elderly men pay less attention to it. They always think that it is a manifestation of natural aging and does not need to be treated. This leads to many middle-aged and elderly patients being unwilling to go to the outpatient clinic for standardized treatment due to erectile dysfunction. As a result, the age structure of erectile dysfunction outpatients in my country is very young compared with that in the West, thus losing a good opportunity to reduce the probability of cardiovascular disease detection.

The severity of erectile dysfunction increases with age, but the age composition of outpatient patients decreases rapidly after the age of 40 to 49 years old, which indicates that most middle-aged and elderly men in my country are unwilling to go to the outpatient clinic for erectile dysfunction.

Figure 2 Copyright image, no permission to reprint

Middle-aged and elderly male patients with erectile dysfunction in my country should seek medical treatment in a timely manner and receive standardized treatment. It is hoped that as the aging process of my country's population accelerates, all sectors of society will care for middle-aged and elderly men and pay more attention to the treatment of erectile dysfunction and the prevention of cardiovascular diseases.

References

[1] Andersson DP, Trolle LY, Grotta A, et al. Association between treatment for erectile dysfunction and death or cardiovascular outcomes after myocardial infarction[J]. Heart, 2017, 103(16): 1264-1270.

[2] Li D, Jiang X, Zhang X, et al. Multicenter pathophysiologic investigation of erectile dysfunction in clinic outpatients in China. Urology[J], 2012,79(3):601-606.