Listen to your body, Erectile dysfunction could be a warning sign of heart attack risk

The researchers suggested that the physicians treating patients with Erectile dysfunction should prioritise comprehensive cardiovascular risk assessments and interventions.

ByChetana Belagere

Published Jun 10, 2024 | 7:00 AM Updated Jun 10, 2024 | 7:00 AM


Erectile dysfunction (ED), often perceived merely as a challenge to a couple’s intimate life, carries far more serious implications than commonly understood. Affecting millions of men worldwide, ED is not just a barrier to sexual satisfaction but a significant marker of broader health issues.

Recent study published in The Journal of Sexual Medicine has shown how ED is intricately linked to major adverse cardiovascular events (MACE), such as heart attacks, heart failure and strokes.

This study highlights the disparity in cardiovascular risk between rural and urban settings, emphasising the need for comprehensive cardiovascular assessments for men with ED.

The study, conducted by researchers at the University of Manitoba, aimed to investigate two primary objectives. First, it explored the association between residence location (rural vs. urban) and MACE risk in men with ED. Second, it confirmed previous findings that ED is an independent risk factor for MACE.

The research was based on a propensity-weighted retrospective cohort study involving 430,621 men from Manitoba, Canada, spanning from June 1996 to March 2018.

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Cardiac risk in men with ED in rural vs urban

The study revealed that men with ED residing in rural areas have a significantly higher risk of MACE compared to their urban counterparts and men without ED. This increased risk persists even after adjusting for income, hypertension, chronic kidney disease, dyslipidemia, and pulmonary hypertension.

Notably, rural men with ED had the highest rates of MACE, underscoring a critical disparity in health outcomes based on geographic location.

The study’s robust methodology involved data collection from the Population Research Data Repository maintained by the Manitoba Centre for Health Policy.

The researchers linked patient demographic data with health administrative databases to assess comorbidities and socioeconomic status. Postal codes determined rural and urban residences, and income quintiles were used as proxies for socioeconomic status.

The study highlights a surprising disparity in health outcomes between rural and urban residents.

While rural patients with acute urologic conditions like septic stones and Fournier’s gangrene – a condition that can cause swelling in the genitals leading to death- do not show higher mortality rates due to effective healthcare system interventions, those with chronic conditions like ED and cardiovascular disease face worse outcomes.

“This disparity suggests a need for targeted interventions in rural communities to manage chronic conditions effectively through long-term lifestyle modifications and medical care,” the study cited.

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Why the study is important

These findings have significant implications for healthcare providers. The researchers suggested that the physicians treating patients with ED should prioritise comprehensive cardiovascular risk assessments and interventions.

“ED often precedes the first cardiovascular event by three to five years, providing an optimal window for preventive measures. By addressing cardiovascular risk factors in men with ED, especially those in rural areas, healthcare providers can improve overall health outcomes and reduce the incidence of life-threatening cardiovascular events,” the researchers said.

They also called for increased awareness and intervention strategies.

Men experiencing ED should not only seek treatment for their sexual health but also undergo thorough cardiovascular evaluations. Healthcare providers should adopt a holistic approach, addressing both ED and underlying cardiovascular risk factors, they suggested.

The findings of this study are a wake-up call for healthcare systems to ensure comprehensive and accessible care for all patients, regardless of their geographic location.

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ED, warning of heart ailments?

South First spoke to doctors from India to know if it is a general practice to check for cardiac issues in people coming in with complaints of ED. However, very few doctors said they looked into this factor.

Dr Pramod Krishnappa, who is not connected to the study, and is a Consultant Uro-Andrologist at NU Hospitals and Orchidz Health in Bengaluru, explained that ED and heart issues have a common underlying problem, which is called as endothelial dysfunction.

He said that research has shown that ED may present three to five years before a heart attack, making it a common first sign for men who may have unrecognised underlying heart disease.

Referring to the study, he said that it highlights the fact that men with ED from rural areas are at a higher risk of heart issues due to lack of access to quality healthcare.

The Canadian study involved 8.25 percent of men with ED living in urban areas and a higher percentage, 10.8 percent of men with ED living in rural areas.

The lack of healthcare facilities and reduced awareness of this correlation between ED and cardiovascular events among the general population and physicians in rural areas could be contributing factors.

Meanwhile, Dr Sudhir Kumar, neurologist from Apollo Hospitals in Hyderabad added that lack of sexual pleasure seems a minor issue, if we look at a major problem associated with ED.

He said that it is associated with a significantly higher risk of cardiovascular diseases (CVDs) including myocardial infarction (heart attack), heart failure and stroke.

ED and CVDs share multiple common risk factors, such as diabetes, high blood pressure, high cholesterol, smoking, alcohol consumption, obesity, advancing age and low testosterone levels said Dr Kumar.

It’s not the ED that increases the risk of CVDs. The similarities between disease process and risk factors between ED and CVDs lead to this association, he added.

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Healthcare strategies to manage ED, CV risks

Using this study as the evidence Dr MSS Mukharjee, Managing Director and Cardiologist at Pulse Heart Super SPeciality Hospital in Miyapur, said the findings shows the disparity in Cardiovascular outcomes between rural and urban population.

Doctors explain that there is a need for physicians treating patients with ED to address cardiovascular (CV) risk factors for primary and secondary prevention of CV diseases.

“The higher incidence of MACEs in rural men with ED, highlights an urgent need for targeted interventions in these communities,” Dr Mukharjee said.

“This research accentuates the necessity for healthcare professionals to adopt a proactive approach in managing ED patients, incorporating rigorous CV risk assessment and preventive strategies,”  he added.

However, Dr Pramod noted that this shouldn’t cause a scare about heart attack in all men with ED, but it’s always safer to consult an andrologist to get evaluated and seek appropriate treatment.

“More public awareness programs about this correlation, appropriate training for healthcare professionals and an availability of healthcare facilities in rural areas may benefit many rural men to get timely intervention,” he added.

(Edited by Shauqueen Mizaj)