The canary in the trousers

Above: Professor Emily Banks discusses the 45 and Up study

By Keryn Curtis

Men aged 45 and over experiencing any symptoms of erectile dysfunction, regardless of age or the severity of the problem, should see their doctor to be checked for cardiovascular disease.

This is the advice flowing from a new Australian study strongly linking erectile dysfunction and heart disease. The research, from the Sax Institute’s 45 and Up Study and published in international journal PLOS Medicine yesterday, is the first to show a direct link between how severe a man’s erection problem is and his risk of dying early or being treated in hospital for heart disease.

The world’s largest study to investigate the link between erectile dysfunction and heart disease has found that men with erectile dysfunction have a higher risk of hospital admission for heart disease, even if they have no history of heart problems. They are also at greater risk of premature death from any cause.

The researchers, from the Sax Institute, Australian National University, The University of Sydney, Victor Chang Cardiac Research Institute and The George Institute for Global Health examined hospital and death records for 95,000 men from the 45 and Up Study – the largest ongoing study of healthy ageing in the Southern Hemisphere, with more than 250,000 people taking part.

The men gave information about health and lifestyle factors and were followed for a two to three-year period from 2006-2009, recording 7855 hospital admissions related to cardiovascular disease and 2304 deaths.

Lead author and 45 and Up Study Scientific Director, Professor Emily Banks, says that while previous studies have shown that men with severe erectile dysfunction are more likely than men with no erectile difficulties to have cardiovascular events such as heart disease or stroke, this study (funded by the Heart Foundation and the NSW Office for Health and Medical Research) is the first to review gradients of erectile dysfunction from none, to mild, moderate and severe forms.

“The risks of future heart disease and premature death increased steadily with severity of erectile dysfunction, both in men with and without a history of cardiovascular disease,” said Professor Banks.

She said it was important to note that the study looked at how good erectile dysfunction was as a ‘predictor’ of heart disease, not a cause.

“Rather than causing heart disease, erectile dysfunction is more likely to be a symptom or signal of underlying ‘silent’ heart disease and could in future become a useful marker to help doctors predict the risk of a cardiovascular problem.

Professor Banks said the large number of men in the study meant researchers could also look at the risks in relation to different types of cardiovascular disease.

“We found men with erectile dysfunction were at higher risk of heart attack, heart failure, peripheral vascular disease and heart conduction problems.”

She added that while some studies had previously showed erectile dysfunction as a better predictor of cardiovascular disease in younger men than older age groups, in this study there was no difference between different age groups.

“It’s the real ‘canary in the trousers’ for heart disease. Essentially it means that men, even with only mild symptoms of erectile dysfunction, should take action and see their doctor for a heart check, if they haven’t already.

“There are really effective ways of managing CVD – cholesterol, diabetes, blood pressure – but men have got to be screened. You wouldn’t necessarily know you had it.

“This is a sensitive topic but men shouldn’t suffer in silence; there are many effective treatments, both for erectile dysfunction and for cardiovascular disease,” Professor Banks said.

To see the study, including an easy to read lay-description of the methodology and findings, go to: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001372

Prevalence of severe erectile dysfunction

Erection problems are very common: around one in five men aged 40 and over report moderate or severe erectile dysfunction. The researchers found that the rates of severe erectile dysfunction among study participants were: