~ 020409 Younger Men with ED May Be At Increased Risk For Heart Disease

In the February, 2009 issue of Mayo Clinic Proceedings, Jennifer St Sauver, PhD and colleagues report the results of a study which found that men between the ages of 40 and 49 who experience erectile dysfunction (ED) have a significantly higher risk of developing heart disease compared to those not affected by the condition. The study builds on previous research published in the Journal of the American Medical Association which detected a link between ED and the development of heart disease, but failed to utilize externally validated questionnaires for ED assessment or conduct a standardized review for the diagnostic accuracy of reported cardiac events. For the current investigation, 1,402 men without heart disease upon enrollment in 1990 in the Olmsted County Study of Urinary Symptoms and Health Status Among Men were screened for ED every two years from January, 1996 through December, 2005 via statistically validated questionnaires. Cardiac events and coronary angiograms diagnostic of coronary artery disease were tracked and confirmed.

At the beginning of the study, 2.4 percent of men aged 40 to 49, 5.6 percent of men aged 50 to 59, 17 percent of those aged 60 to 69, and 38.8 percent of men 70 and older reported ED. Over the ten year follow-up period, coronary heart disease developed in 11 percent of the participants, and was 80 percent likelier to occur in men with ED. Men with ED between the ages of 40 and 49 experienced a 50 fold greater risk of developing heart disease than men in the same age group who did not report the condition. Although the development of coronary artery disease was also higher in older men with ED compared to those without it, the effect was not as great as that observed in younger subjects. "The highest risk for coronary heart disease was in younger men," observed Dr St Sauver, of the Mayo Clinic's Division of Epidemiology. "In older men, erectile dysfunction may be of less prognostic importance for development of future heart disease."

The same plaque buildup or loss of elasticity that affects the arteries of the heart may initially show their effect in the penile arteries, reducing blood flow and providing an early warning for heart disease. "Erectile dysfunction and coronary artery disease may be differing manifestations of a common underlying vascular pathology," the authors conclude.

"The importance of the study cannot be overstated," commented Martin Miner, MD of The Miriam Hospital in Providence, Rhode Island in an accompanying editorial. "Although ED had little relationship to the impact on the development of incident cardiac events in men aged 70 years and older, it was associated with a nearly 50-fold increase in the 10-year incidence in men 49 years and younger. This raises the possibility of a 'window of curability,' in which progression of cardiac disease might be slowed or halted by medical intervention."

Related Health Concern: Erectile Dysfunction

Risk factors for erectile dysfunction (ED) include conditions such as high blood pressure, abnormally high blood lipids (i.e., elevated low-density lipoprotein cholesterol and triglycerides), obesity, diabetes, and smoking (McKay D 2004). Recently, some US scientists reported that it may be necessary to add aging itself to the list of risk factors that produce vascular dysfunction of the kind associated with ED. "The normal aging process may induce significant global vascular dysfunction (involving the endothelium and the vascular smooth muscle)," wrote scientists published in the International Journal of Cardiology. This age-associated dysfunction was judged to occur even in the absence of clinically diagnosed atherosclerosis and was related to alterations in the production of endothelial nitric oxide (Al-Shaer MH et al 2006).

The link between ED and vascular disease is so strong that physicians are advised to consider men who present with ED but no diagnosis of heart disease as undiagnosed cardiovascular patients until proven otherwise (Jackson G et al 2006). It is believed that alterations in the availability of vascular endothelial nitric oxide represent the common thread linking these interrelated pathologies (Sullivan ME et al 1999).

Arginine has been shown to improve ED and other nitric oxide–dependent conditions, including atherosclerosis (Napoli C et al 2006). One recent study of healthy people who took sustained-release arginine showed that a moderate dose improved endothelial function and blood pressure. Blood pressure reductions, especially in patients with borderline or frank hypertension, occurred after just one week of L-arginine therapy (Miller AL 2006).

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