Erectile Dysfunction And Heart Attacks

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Do you know that ED is a symptom of Heart Attacks and Strokes?

ED, or Erectile Dysfunction, has become a household word, ever since the drugs Viagra, Cialis and Levitra were approved by the FDA as a treatment, but the significance of ED as a sign of a disease more ominous is rarely discussed. It is a fact that ED is an early sign of a more serious condition—atherosclerosis– better known as hardening of the arteries. Today we are going to talk about ED as the first physical sign of heart disease and stroke, and why the appearance of this symptom should trigger a more extensive medical evaluation than just treating you with a “blue pill”.

ED is a sign and a symptom, of future coronary artery disease. It should be a normal thing for a primary care doctor to ask a patient if they smoke, or experience shortness of breath which is a sign of COPD (emphysema). It should be a routine question to ask a man if he has erections as a way to investigate his current testosterone level, as well as his future risk of heart disease and stroke. It is a fact that men with ED have 1.5-2.5 times the risk of having a heart attack and stroke in the near future. This risk is similar to a person who smokes or has diabetes. It is also a fact that ED is related to a low testosterone level. Determining which comes first, and what to do with this information is a doctor’s task.

When faced with the complaint of ED from a patient, doctors should think immediately about low blood testosterone level, and heart disease. This realization of this symptom as “risk factor” should trigger testing of the heart with a complete cardiac evaluation, lipid testing and stress test. ED is a symptom of disease, not just a problem that needs a simple pill to fix it. If ED were considered in this way, early intervention could take place, and the biggest killer of Americans could be prevented or delayed.

In every disease process in every one of my patients, I automatically review the physiologic process of a disease in my mind, while I am interviewing my patient. The group of symptoms, what makes them better, worse, and what triggers them means a great deal to diagnostic physicians who spent their time digging for the cause of a disease. Remember that not all doctors must do this to provide care, eg surgeons “ fix disease” by physical means, psychiatrists may want you to discover the answer to the complaint you came in with through talk therapy instead of digging for the inciting life event. Since I am now in the role of doctor detective, the FIRST problem that began the disease cascade is very important because if I can “nip a disease in the bud” I can provide my patients with the opportunity to lead productive and fulfilling lives for their entire life span.

Here are the facts about ED and what it means. ED is an early symptom of:

  • Low testosterone which triggers high cholesterol, inflammation, and decrease in nitric oxide (vasodilator) which leads to arterial plaque, decrease of blood flow to the penis, and finally erectile dysfunction.
  • CVD disease from narrowing of the arteries which decreases blood flow (see above) to the penis, heart and brain.
  • Atherosclerosis (hardening of the arteries which leads to heart attack and stroke) which prevents the dilation of vessels to help feed the penis, heart and brain when you need more blood flow.
  • Diabetes which damages the blood flow of the pelvis, and extremities.
  • Hypoxia (low oxygen), which can come from lung disease, poor heart pump (heart failure), anemia, and many other circulatory and lung diseases.
  • Low cholesterol. We need cholesterol to make testosterone which increases blood plw to the pelvis when needed and increases NO production in the pelvis and heart (dilates blood vessels and increases blood flow). This problem can be familial, or from too much statin medication.
  • Low blood pressure, either from too aggressive a doctor who thinks that there is no limit to how low your BP should be, or other medications that lower the BP.
  • Diet pills and other medications that constrict blood vessels like diet pills, amphetamine, and ADD medications.

Today we are talking about ED as the first sign of heart disease and future stroke.
One new study found that ED occurred an average of 53 months (4+ years) before a heart attack or stroke. The penis is more sensitive to impaired blood flow and should be recognized as such!

Younger men are not immune. When ultrasound dopplers were done on their carotid arteries and coronary calcium testing was done with a CT scan, they already had compromised arterial flow and arterial plaque. In addition, younger men with ED had a poor NO (nitric oxide) levels (low testosterone causes low NO). It is the substance that is increased when men take ED drugs and as it turns out Nitroglycerin!

Because of these facts, when you experience ED please don’t accept a prescription for Viagra without any other work up! Every man with ED should be evaluated with testing including :

  1. Low total and free testosterone
  2. Heart disease
  3. High lipids
  4. Diabetes
  5. High and Low Blood pressure
  6. Hypoxia and anemia
  7. Hemochromatosis which sludges blood and deposits iron in the testes and blood vessel
  8. Vascular capacity with Doppler studies

Many of these problems we can treat and men can avoid heart disease and stroke if they know early enough. We need a change in how we prevent disease as physicians. It requires informing patients of the facts, offering testing and replacement of disappearing hormones, aggressive diet and exercise revisions, and laying our cards on the table for our patients so they can decide if they want to prevent future disease and impairment or just let it happen. This will be a New Age of Medicine that is transparent without the old barriers of worrying about “scaring patients” or “hurting their feelings”. Doctors must do a better job of uncovering the danger they see, and lighting the path for their patients toward knowledge of their risks, and how to prevent future disability and death. As a patient, don’t accept less!

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author.

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