August 17th, 2011
10:08 AM ET

Erectile dysfunction: The leading indicator of heart disease in men

Editor's note: Dr. Sanjay Gupta explores the signs, tests and lifestyle changes that could make cardiac problems a thing of the past on "The Last Heart Attack," Saturday, August 27,  8 and 11 p.m. ET.

Dr. Dean Ornish who designed a diet and lifestyle to reverse heart disease will be live with CNNHealth to answer your questions. He will answer your questions Thursday, August 18, at noon EST.  Follow #LastHeartAttack on Twitter and Tweet your questions to @CNNhealth or ask them in the comment section here.

What's the leading indicator of heart disease for men? It's a surprising answer that affects at least 30 million men in the United States but most men don't talk about, according to the National Institute of Health.

The answer is erectile dysfunction, difficulty maintaining an erection sufficient for sex. "I would say that erectile dysfunction is the canary in the coal mine," says Dr. Terry Mason a urologist and chief medical officer at Cook County Hospitals in Chicago. "When men begin to have erectile dysfunction it's a sign that there's more widespread disease and not just for the heart but throughout all the blood vessels in the body."

"In the penis, what we learned is those cells, those cells that line the blood vessels – those things we call the endothelial cells, they're more of those per unit volume in the penis than anywhere else in the body. So any disease that causes a problem with those cells, is going to manifest itself in a male particularly, as erectile dysfunction," adds Mason.

Understanding the connection between ED and heart disease is especially important because it may help in early diagnosis and treatment before heart problems become serious. When we talk about heart disease, we're usually talking about plaque building up in the blood vessels leading to the heart and limiting the amount of blood able to pass through them. But those blood vessels aren't isolated and they are connected to the rest of the body, and one blood vessel in particular is particularly sensitive to a narrowing that limits blood flow.

Researchers found erectile dysfunction to be a strong predictor of death in men with cardiovascular disease, and those men with ED were 1.6 times more likely to suffer from a serious cardiovascular problem such as a heart attack or stroke, according to a 2010 study in the Journal of the American Heart Association.

Age also plays a role. The younger men are, especially those under age 50, it's more likely that erectile dysfunction is a sign of a cardiac issue. In men over age 70, it's much less likely to be a sign of heart disease.

For men having issues with ED, they should talk to their doctors about a cardiology workup to determine existing cardiovascular disease and proper treatment. A lifestyle change maybe necessary as well. Eating better, watching cholesterol, stopping smoking, and exercising more may be beneficial. While drugs for erectile dysfunction may cure the initial problem, they do not protect against cardiovascular or other life-threatening illnesses so figuring out the root of the problem first is key.

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soundoff (119 Responses)
  1. Victor

    What about ED caused by a man's wife getting fat and nasty...I guess we would call this a false positive.

    August 17, 2011 at 11:44 | Report abuse | Reply
    • JDT


      August 17, 2011 at 12:32 | Report abuse |
    • Lila

      Considering it's the male with the potential heart disease, he's probably the fat nasty one. I think the message is: eat healthier, exercise and you won't suck in bed anymore.

      August 17, 2011 at 12:45 | Report abuse |
  2. Skottikins


    August 17, 2011 at 12:39 | Report abuse | Reply
  3. Nick

    talking to your penis?

    August 17, 2011 at 12:40 | Report abuse | Reply
  4. Rico

    Look ladies! no heart disease!

    August 17, 2011 at 12:44 | Report abuse | Reply
    • Scott

      Lol. Well done.

      August 17, 2011 at 12:54 | Report abuse |
  5. Nick

    I really pity the men with ED... i'm 43 and never had this problem... must be hell...

    August 17, 2011 at 12:44 | Report abuse | Reply
    • kb

      You're not 50 yet

      August 17, 2011 at 14:04 | Report abuse |
    • Willy R

      You are lucky Nick, mine started @ 44 and never returned, was not till 13 years later found out I had Venous leakage, inability to maintain an erection and Nothing can be done about it. NO HEART Problems, always excercised, not over weight and had a physically demanding job. And a Hot Wife. Yeah, she is still with me!!

      August 17, 2011 at 15:00 | Report abuse |
    • cando

      Just wait till 50. Its coming sooner than you think.

      August 17, 2011 at 15:26 | Report abuse |
    • Marv

      Willy, did you say your pen*s is leaking? So you can't even use Viagra? I'll take care of your hot wife for you. You can even hang out. No worries & no need for thanks.

      August 17, 2011 at 18:42 | Report abuse |
    • John

      Hi Nick, it IS hell but I'm 72. I can get injections that go into the penis which help somewhat but they are SO expensive as to not be a viable option for a pensioner. I have a beautiful partner, the feelings are all there but my ED lets me down. I am a bit overweight so I'll continue working on reducing that and try to get more exercise. Very frustrating!

      September 6, 2017 at 08:35 | Report abuse |
  6. Renelda Moorehead

    STRESS, WHAT ABOUT PROLONGED NEGATIVE STRESS, AS A PREDICTOR OF POOR HOLISTIC HEALTH. I wonder if there have ever been cases where ED was reversed once the root-cause was found to be prolonged negative stress, and that cause was REMOVED? aNYBODY HAVE THE ANSWER?

    August 17, 2011 at 12:49 | Report abuse | Reply
    • cando

      So, what's stressing you?

      August 17, 2011 at 15:27 | Report abuse |
  7. Nena

    Having lost someone that I loved last year due to sudden death from a heart attack and the coroners report indicated massive heart disease as the cause. He was 50 years old, a smoker who had been over weight but lost the weight and made life style changes which came too late to save his life. ED was prevalent and he did not want to seek help or advice on that issue. The bottom line is that the article is right on the money.

    August 17, 2011 at 12:53 | Report abuse | Reply
  8. Angelo Tomedi, MD

    I am dismayed to see another inappropriate recommendation based on poor-quality information. All this leads to is more unnecessary testing and treatment, leading to unwarranted side effects and expense. Where is the evidence that identifying men with ED and doing a "cardiac workup" improves important outcomes like less heart attacks, strokes, or premature deaths? Of course, when someone has an important problem like ED, it should be treated. And nearly ALL men would likely benefit from some healthy lifestyle changes (exercise, weight management, healthy eating habits, etc) REGARDLESS of whether they have ED or get exposed to a "cardiac workup". We should be using good evidence to put our resources where we know we can make a difference in people's lives.

    August 17, 2011 at 12:54 | Report abuse | Reply
    • David

      Unnecessary? Unwarranted? Really? If someone with ED is more likely to die from, and 1.6 times more likely to have a major coronary event, then it seems pretty careless to not want to have an angiogram or similar diagnostic testing if a predictor like this occurs. If the check engine light comes on in your car, do you just keep driving it a pretend it's not there?

      What is poor-quality about the evidence? If this is 'new' evidence about a correlation between coronary events and ED, then of course there is probably not yet going to be evidence that testing and treating will lead to positive outcomes – but it stands to reason doesn't it?!

      Yes, eating well and exercise is ALWAYS beneficial weather you have disease or not, so it's beside the point.

      August 17, 2011 at 13:31 | Report abuse |
    • Willy R

      Dr., had the Cardiac work up, Heart AOK, lost ability to maintain an erection @ 44 and it never returned. I am now 66, but wasn't till age 57, found out (Mayo Clinic) that I had Venous Leakage, of which there is NO CURE, I am a NON Smoker, all my life, drank very little, excercised (still do) and had a physically demanding job, but did NO good, other than my Heart is Healthy. I don't go along with the analogy that ED is a sign of Heart disease or an approaching problem. I figure God Does not like me for some reason, even though I still Love Him.

      August 17, 2011 at 15:07 | Report abuse |
    • cando

      Poor Willy. Caught between a bum rap and his own pitty party. I don't envy him at all.

      August 17, 2011 at 15:32 | Report abuse |
    • Rich in NJ

      @David: it doesn't necessarily "stand to reason". You can have a correlation without testing/treatment being effective – for example, there could be some other underlying cause of both the ED and the coronary event that is not treatable. Suppose that some other cause (genetic defect, for example) is responsible for both symptoms; you would have correlation without effective treatment. So while it may well "stand to reason" that treatment would work, you can't know that without a controlled study. The article also says that the correlation declines with age. A controlled study would tell you when ED should begin to be ignored as a warning (55? 60? 65?). I also find it difficult to believe that ED is "THE leading indicator" of heart disease – are they saying it's a stronger indicator than morbid obesity?

      August 17, 2011 at 22:20 | Report abuse |
  9. haroon


    August 17, 2011 at 14:08 | Report abuse | Reply
    • cando

      Never felt what?

      August 17, 2011 at 15:32 | Report abuse |
  10. BigDogMom

    When you're reading this article, do read beween the lines and remember that ED isn't *always* a sign of cardiovascular issues, it's simply a risk factor (or, put better, there is a correlation.) My husband has had ED since his teens, and because of it has had more heart checks than I can count, all of which have found him to be as healthy as a horse.

    So bottom line, guys: If you have ED, don't panic. Reading this artcile doesn't mean a stroke is imminent! Get checked, because that's smart to take care of yourself. Get treatment, because that's kind to take care of your partner. And then life goes on. It's not that much of a deal-breaker if we love you 🙂

    August 17, 2011 at 14:30 | Report abuse | Reply
    • cando

      You can never replace common sense no matter how you write the article.

      August 17, 2011 at 15:34 | Report abuse |
    • freeat40

      I like the common sense part from cando. My hubs has a bad family history with heart issues and he is starting to experience ed issues. I'll be saving these articles for him when he is ready to face his history, having a hard time getting him to accept he needs to take responsibility for his health.

      August 17, 2011 at 22:14 | Report abuse |
  11. cynic

    Wasn't Viagra originally developed as a vasodilator for heart disease, but turned out to work selectively better on the penis and lungs than other parts of the body? Seems likely that both ED and some heart disease are just different symptoms of the same problem.

    August 17, 2011 at 14:43 | Report abuse | Reply
    • Aspen

      If you wrote an article about life we'd all reach enilgthenemnt.

      October 9, 2011 at 17:06 | Report abuse |
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      October 10, 2011 at 05:03 | Report abuse |
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      October 12, 2011 at 06:33 | Report abuse |
  12. Limp_Peter

    I dunno....but when I had a hot girlfriend I had no issues. I married this HOT ONE & she ballooned up and my unit wouldn't work anymore. got rid of her & now it's fine again. GO FIGURE!

    August 17, 2011 at 15:01 | Report abuse | Reply
    • cando

      Arrousal is 75% mental.

      August 17, 2011 at 15:34 | Report abuse |
    • Chris

      Wow, the kiddy pool isn't even as shallow as that comment....charming...

      August 20, 2011 at 19:36 | Report abuse |
  13. us1776

    If you need Viagra you probably need a good stress test from a cardiologist.


    August 17, 2011 at 15:17 | Report abuse | Reply
  14. cando

    What does it say about my heart if I need salt peter?

    August 17, 2011 at 15:37 | Report abuse | Reply
  15. Schmedley

    "I had a heart attack but never had problems with MY willy..."

    People, it's about probability not absolutes. Just because you smoke doesn't mean you WILL get lung cancer. However, it does mean that your odds of getting it are much higher.

    Think of it like playing roulette at a Casino. If you eat well and exercise, you have to hit 00 to get a heart attack. If you smoke, drink and are a fat, lazy turd, then if you hit Red you get a heart attack.

    What this article is suggesting that if if you ED before 50, then statistically your odds of having a heart attack are higher because it is POSSIBLE that it is a leading indicator...

    August 17, 2011 at 18:30 | Report abuse | Reply
  16. Josef

    I hope this is all bunch of crap! I'm 57, my diet is very good, I'm lean and have no family history of a heart attack. I've been an athlete most of my life (at least last 43 years), moving from sport to sport as I age. Yet, I take the blue pill since about the age of 48. Would that mean I have a cardio problem? I hope this dr is full of crap.

    August 17, 2011 at 19:11 | Report abuse | Reply
  17. Willy R

    Yeah Right Marv, That ain't happening !!!!!!!!!!!!!!!

    August 17, 2011 at 21:48 | Report abuse | Reply
  18. Navybill

    WOW!! When did this newsworthy story first break???? Any good doctor could have written this years ago. Yes, ED is a precursor to such things as CAD. Please be advised folks that plaque does not just deposit in the penis or heart, it is non-selective in where it deposits. If you have a good doctor he may suggest a CIMT just to measure the carotid inti-media deposit, which is a fair indicator of whole body plaque build-up. If this simple test comes back with significant depositing a coronary calcium scan may be in order.

    August 18, 2011 at 08:54 | Report abuse | Reply
  19. 9 of 1

    Anyone know if there is a correlation between ED, plaque and elevated blood pressure?

    August 18, 2011 at 09:21 | Report abuse | Reply
    • Navybill

      Yup, sorry.

      August 18, 2011 at 10:20 | Report abuse |
  20. Oreste Ona

    I am 73, and don't have any problem. My grandfather, from my mother side died from a heart attack when I was 5. Four of my uncles (his sons) died from heart attacks. And from my grandmother's side, relatives died also from heart attacks. BUT: never ever we heard about erectile disfunctions. It would have been a record!

    August 18, 2011 at 10:14 | Report abuse | Reply
  21. c brown

    My husband had a quadruple bypass two years ago and still has the ED problem. The cardioligist doesn't really say much. But I am concerned that there is still an issue with his arteries? Is there more we should be doing about this?

    August 18, 2011 at 12:15 | Report abuse | Reply
  22. Charlie Brown

    Read "The China Study" by Dr. T. Colin Campbell.

    August 20, 2011 at 01:30 | Report abuse | Reply
  23. berchman

    I didn't have ED until I started taking Flomax because of problems urinating due to an enlarged prostate. This happened in my 60's. The alternative to Flomax is urinary blockage which is an emergency room situation and requires surgery or the kidneys will fail. Women complain about their "plumbing," but we men have our problems too. Aging sucks.

    August 20, 2011 at 07:49 | Report abuse | Reply
  24. mike

    This is very timely information and well written

    September 6, 2011 at 13:04 | Report abuse | Reply
  25. Shaz W

    Isn't one of the key factors that links ED and heart disease is every day stress? Our modern day lives seem to create more and more stress. sometimes without even knowing. Stress is one of the biggest killers that we face.

    January 8, 2012 at 13:05 | Report abuse | Reply
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    January 24, 2012 at 17:14 | Report abuse | Reply
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    February 21, 2012 at 00:11 | Report abuse | Reply
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    June 9, 2012 at 07:47 | Report abuse | Reply
  29. pointpoint2

    Erectile dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse.
    Erectile dysfunction (ED), also known as impotence, is the inability to achieve or sustain an erection for satisfactory sexual activity. Erectile dysfunction is different from other conditions that interfere with male sexual intercourse, such as lack of sexual desire (decreased libido) and problems with ejaculation and orgasm (ejaculatory dysfunction). This article focuses on the evaluation and treatment of erectile dysfunction.
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    June 25, 2012 at 00:33 | Report abuse | Reply
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    September 11, 2012 at 13:11 | Report abuse | Reply
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    December 4, 2012 at 02:14 | Report abuse | Reply
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    Of all conditions affecting today’s male, erectile dysfunction or impotence is the one of the commonest and yet most discreet. No man will ever tell you that he is suffering from erectile dysfunction. Why? A man’s masculinity is usually determined by his success, potency and virility. Erectile dysfunction is thought to be a hindrance to all three since it affects his ability to have children and to perform. Shame and inadequacy overshadows his logic and become his constant companions. Man feels incomplete if he cannot even produce an erection.'

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    February 12, 2013 at 07:31 | Report abuse | Reply
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    I am only 40. Started having problems about a year ago. Tried "herbal" remedies, was hit or miss, mostly miss. Also libido was on the down turn, I just didn't feel like I needed or wanted sex... Got a trial pack from http://aroma-health.com/ with 6 pills. The first three I took worked perfectly. Took on empty stomach or at least one hour after a meal. Within an hour, took effect. Makes my face flush and nose run (common side effects) The fourth time I took it, I split the pill in half to see if it would work at lower dose (I was taking a 50mg dose) It works. Also, most of the time, it still has effects several hours after. Even up to the next morning if taken at night.

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    July 11, 2014 at 06:22 | Report abuse | Reply
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  39. Tom

    Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but can often be helped.

    Erectile dysfunction can have severe psychological consequences as it can be tied to relationship difficulties and masculine self-image generally.

    Source: http://erectiledysfunctionprotocol.info

    January 15, 2015 at 19:01 | Report abuse | Reply
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