It may not be performance anxiety that keeps some men down — it could be that those suffering from erectile dysfunction can blame their sexual infirmity on heart disease. Researchers from the University of Chicago claim they have established a link between erectile dysfunction and aberrant results on cardiac stress tests, but Yale physicians are dubious about the results.
While it has been known for some time that erectile dysfunction can be caused by vascular disease, the new Chicago research aimed to define a relationship between sexual function and results from nuclear stress testing — an imaging study that allows doctors to see blood flow to the heart while the patient is subjected to simulated stress. But Yale cardiologist and professor of internal medicine Dr. Harlan Krumholz said more and better studies are necessary to characterize how erectile dysfunction is related to heart disease. Krumholz said the main reason for his skepticism is that the test subjects were poorly suited to answer the question the study set out to answer.
“The link between erectile dysfunction and heart disease is definitely worthy of being tested, but there are so many other reasons why people might have erectile dysfunction,” Krumholz said. “I just don’t think we know quite yet where it fits in with risk factors concerning heart disease.”
He said the researchers at the University of Chicago studied a group of men who had already been referred for nuclear stress testing based on the appearance of traditional risk factors like high cholesterol or hypertension — these men were already suspected of having heart disease. The study then found that over 50 percent of the test subjects suffered from erectile dysfunction, but, Krumholz explained, the application of these findings is problematic because the population studied was so narrow.
Chicago researchers are positing that doctors use the diagnosis of erectile dysfunction to screen for nuclear stress testing candidates, but Krumholz said the study does not demonstrate that this recommendation will be effective because the subjects had already been recommended for nuclear stress testing based on other, more traditional indicators.
“Even if there is an association between cardiac disease and erectile dysfunction, it doesn’t mean that it would be a good test for screening because there are a lot of people with erectile dysfunction that don’t have heart problems,” Krumholz said.
But Harris Foster, a professor of surgical urology at the Yale School of Medicine, said that since many patients with heart disease also suffer from vascular disease, and an erection requires a good blood flow, it would not be too great a stretch to posit a link between cardiac disease and erectile dysfunction.
Both Foster and Krumholz explained that an erection is all about blood flow — both the ability to redirect blood flow to the penis as well as the ability of the penis to hold the blood once it is full — so for men who have vascular problems, getting and maintaining an erection can be problematic.
“Knowing that many of the other causes are not too common, I think it would be safe to say that cardiovascular disease is the most common cause of erectile dysfunction,” Foster said.
Krumholz added that problems with the penile arteries might be cause for concern about other blood vessels in the body.
“For someone to get an erection, the arteries have to be quite healthy, so if something is wrong with penile arteries there might be problems with arteries somewhere else too,” Krumholz said.
Although neither cardiovascular disease nor erectile dysfunction is prevalent amongst college-aged men, some male students did say they were troubled by the University of Chicago study.
“It really would be a shame to have both heart disease and erectile dysfunction at the same time,” said one male student who asked to remain anonymous. “And the fact that heart disease runs in my family makes this even more worrisome.”