Silent heart worry in sexual dysfunction

New Delhi, Jan. 29: Sexual dysfunction in men may be a signature of silent, unrecognised cardiovascular disease, independent studies from India and Australia exploring previously observed links between the two health conditions have suggested.

Doctors at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, have found that symptoms of erectile dysfunction (ED) seem to precede symptoms of coronary artery disease (CAD) by about two years in patients with CAD.

The Australian study, using a statistically stronger methodology, has found an increased risk of cardiovascular disease and death with increasing severity of ED in men, even in men who had no history whatsoever of heart problems.

While many studies in the past have shown that men with ED are at increased risk of heart attacks or strokes, the Australian study is being described as the first to show that even minor ED may be related to silent heart disease.

"The take-home message is that men with ED also need to be assessed for cardiovascular disease," Emily Banks, professor of epidemiology at the Australian National University and scientific director of the study, told The Telegraph.

While hormonal, neurological and psychological factors are known to influence a man's ability to get and maintain an erection, doctors have long suspected that ED is predominantly the result of underlying cardiovascular disease.

"Damage and thickening of the inner lining of the blood vessels appears to be the common mechanism for ED and cardiovascular disease," said Pravin Goel, head of cardiology and a team member at the Sanjay Gandhi Institute.

Goel and his colleagues questioned 175 patients with either suspected CAD or symptoms of CAD and found that 70 per cent had symptoms of ED. Also, eight in ten patients with CAD had experienced symptoms of ED on an average about 24 months before the onset of their coronary symptoms.

The Sanjay Gandhi Institute doctors published their findings last week in The Journal of Sexual Medicine.

The Australian study, published this week in the journal PLoS Medicine, followed up 95,038 men, making it the world's largest study to probe the ED-cardiovascular disease connection. About 65,000 of these men had no history of cardiovascular disease.

Banks and her colleagues have said their results suggest that ED is a "risk-marker" ' an indicator of the severity of underlying cardiovascular disease ' rather than a risk factor (a cause of cardiovascular disease).

"The reason why ED can serve as an early marker of silent cardiovascular risk is not exactly known, but it has been termed 'the canary in the trousers'," Banks said.

"It is possible the arteries of the penis are smaller and more sensitive to problems with the lining of the blood vessels than those in the heart, brain (and) limbs and, so, may show problems before a man experiences symptoms of overt cardiovascular disease."

Doctors say the findings are particularly relevant to India where many men do not receive appropriate treatment for ED.

"Unfortunately, in India, ED is not often reported by men and remains under-treated by doctors," said Anoop Misra, an internal medicine specialist and president of the Centre for Diabetes, Obesity and Cholesterol Disorders, New Delhi, a private healthcare institution.

"Cardiovascular evaluation is a must for patients with ED. Unfortunately, because of the stigma associated with ED, men don't often reach out to doctors and those who do often do not get assessed for their cardiovascular risks," said Aneesh Srivastava, a urologist and team member at the Sanjay Gandhi Institute.

The institute team found striking differences in the incidence of CAD between men with ED and those without the problem. About 80 per cent of men with ED had multiple-vessel CAD in contrast with 36 per cent of men without ED.

"Although there are many causes of ED, cholesterol deposition and dysfunction of the small arteries of the penis is among the most important, signifying that similar processes may be occurring in the coronary arteries," said Misra, who was not associated with either study.

The Australian study has also revealed links between ED and previously unsuspected conditions such as heart failure and problems with the conduction of the heart. Most earlier studies had connected it only with CAD.