Because penile arteries are only about half the size of the coronary arteries in the heart, erectile dysfunction can be a powerful predictor of cardiac events such as sudden death.
Thanks to Ellen Reid, Maxim Fetissenko, PhD, and Laurie-Marie Pisciotta and for their keynote help.
Erectile dysfunction is defined as the recurrent or persistent inability to attain and/or maintain an erection in order for satisfactory sexual performance. It is present in up to 30 million men in the U.S. and approximately 100 million men worldwide. Wait a second. The U.S. has less than 8% of the world's population, yet up to 30% of the impotence? We're number 1!
Who cares, though, we've got red, white, and blue pills like Viagra. The problem though is the pills just cover up the symptoms of vascular disease, and don't do anything for the underlying pathology. Erectile dysfunction and our #1 killer coronary artery disease are just two manifestations of the same disease: inflamed, clogged, and crippled arteries, regardless of which organ. Atherosclerosis is considered a systemic disorder that uniformly affects all major blood vessels in the body. Hardening of the arteries can lead to softening of the penis because stiffened arteries can't relax normally, open wide, and let the blood flow. So erectile dysfunction may just be the flaccid tip of an iceburg in terms of a systemic disorder. In two-thirds of men showing up to emergency rooms for the first time with crushing chest pain, their penis had been trying to warn them for years that something was wrong with their circulation.
Why does it hit the penis first? Because the penile arteries in the penis are half the size of the coronary artery in our heart—that's the so-called widow-maker. So the same amount of plaque in the heart, that you wouldn't even feel, could half clog the penile artery causing symptomatic restriction in blood flow. You may not feel chest pain until about here. That's why erectile dysfunction has been called penile angina. In fact, by measuring blood flow in a man's penis you can predict the results of his cardiac stress test with an accuracy of 80%. Male sexual function is like a penile stress test, a ‘window to the hearts of men.’
40% of men over 40 have erectile dysfunction. Men getting erection difficulties in their 40s have a 50-fold increased risk of having a cardiac event like sudden death. You've heard me say various things increase heart disease risk by 20% or 30%. This is nearly 5000%, leading the latest review to ask, is there any greater risk? That's because it’s not so much a risk factor for atherosclerosis, it is atherosclerosis. A man with erectile dysfunction (even if he doesn’t have cardiac symptoms) should be considered a cardiac patient until proved otherwise. It's considered to be a cardiac equivalent; it's a marker of the coronary artery you likely already have. Thus, there’s more to treating ED than establishing an erect penis; it offers an opportunity for reducing cardiovascular risk.
The reason even young men should care about their cholesterol is because it predicts erectile dysfunction later in life, and that predicts heart attacks, strokes, and a shortened lifespan. Just going to keep eating crap because you can pop some pills? All the Viagra in the world may not help your sex life after a stroke. The take home message is a simple equation: ED stands for early death.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Ariel Levitsky.
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Previous videos on the subject include:
A similar relationship appears to exist for female sexual function as well: Cholesterol and Female Sexual Dysfunction.