Erectile dysfunction (ED) is the persistent inability to get or keep an erection firm enough for sexual intercourse. While this may seem a sexual problem, it may indicate an underlying health condition. For instance, it can be a warning sign of future or current cardiovascular conditions. Studies have shown that having ED is as high a risk factor for heart disease as a family history of cardiovascular disease or smoking.

Similarly, if you have a heart disorder, you are at an increased risk of ED. But getting the right treatment for cardiovascular disease may help you prevent ED. Besides, many risk factors for heart disorders such as diabetes, hypertension, and obesity are also prevalent in men with ED. Managing these risk factors can help prevent erectile dysfunction

Understanding the link between them will help you take the right measures and treatment.

Link Between ED & Heart Disease

The erection occurs through two mechanisms, psychogenic erection, and reflex erection. Reflex erection happens when there is physical contact with the penis, while psychogenic occurs due to emotional or erotic stimuli. Erectile dysfunction occurs when erection does not happen due to either mechanism.

Various factors are responsible for a healthy erection, including blood supply to the penis. This means if something interferes with the circulation and thus blood flow to the penis, it may make it difficult to maintain or get an erection.

One such disorder is atherosclerosis, a condition that hardens or narrows your blood vessels. The small blood vessels, such as those in the penis, are also affected by atherosclerosis, resulting in reduced penile blood supply that makes erection difficult. Erectile dysfunction can thus be a sign of heart disease.

The blood vessel lining plays an essential role in the production and repair of blood cells by producing substances such as nitric oxide (NO). These regulatory factors also regulate blood flow by controlling the contraction and relaxation of blood vessels.

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Usually, the stress of an increased blood flow in the penile artery produces NO, which relaxes the blood vessel, further improving the blood flow. All these events aid in penile erection. However, in erectile dysfunction, the synthesis of NO is reduced, and there is the death of cells lining the blood vessels (endothelial cells).

This endothelial dysfunction is a prevalent cause of atherosclerosis, which increases the risk of cardiovascular disorders. Thus men with ED are at an increased risk for heart diseases.

How Serious Is It?

Erectile dysfunction is a widespread problem affecting almost one in four Canadian men above the age of 40. However, failure to get an erection less than 20% of the time is considered normal and can be due to various reasons, such as stress. Treatment is rarely needed in such cases.

But failure more than 50% of the time is an indicator of a physical or psychological problem and needs treatment.

Talking about the link between ED and heart disease, the association is strong. Studies have shown that about 64% of the men hospitalized for a heart condition and 57% of the men who had bypass surgery had ED at some point in time.

Besides, having ED, especially in the absence of other causes like injury, may indicate that the man will probably have a cardiovascular condition within five years. So, if you have ED without any history of trauma or surgery, it is good to talk to your doctor and screen yourself for heart conditions.

Risk Factors

Cardiovascular diseases and erectile dysfunction share the following risk factors (Figure 1):

Figure 1: Risk factors for cardiovascular diseases and ED

  • Tobacco use: Smoking increases the risk of blood vessel disorder and can cause ED.
  • Diabetes: Men diagnosed with diabetes are at a higher risk of heart diseases and erectile dysfunction.
  • Hypertension: Long-standing high blood pressure may damage the lining of your blood vessel and cause vascular conditions. Certain hypertension medicines, such as diuretics, can also cause ED
  • Excess alcohol consumption: Having too much alcohol can trigger other causes of heart diseases such as abnormal cholesterol levels and hypertension. It also impairs erection.
  • Age: As you age, you are at a higher risk for both cardiovascular diseases and ED.
  • High cholesterol levels: It can cause atherosclerosis, a risk factor for heart disease and erectile dysfunction.
  • Low testosterone levels: Men with low testosterone levels are more likely for cardiovascular disease and ED than men with normal levels.
  • Obesity: It worsens other risk factors for heart diseases such as diabetes and hypertension.
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Some common symptoms of ED are:

  • Difficulty in getting an erection
  • Difficulty in maintaining the erection
  • Loss of sexual desire

Assessing the Patient

To confirm the diagnosis of ED, your physician will ask your questions and run a physical check. They may also advise urine and blood tests to ensure the cause of ED, such as low testosterone levels and diabetes

Once the diagnosis of erectile dysfunction is confirmed, they may refer you to a sexual health expert or prescribe medicines to manage the same. If they feel that pills are not suitable, other treatment options may be recommended (more on this below).

Also, even if you do not have any symptoms of erectile dysfunction or are diagnosed with a heart disorder, you can discuss the probability of getting it in the future with your physician. They can help you with lifestyle changes and other precautions you can take to prevent ED.


Understandably, many men with ED find it difficult to discuss their problems with a doctor. But consulting a physician is crucial as they will help you find out if an underlying cardiovascular disease is causing ED.

They can also prescribe medicines or other treatment options for ED and associated problems. An early diagnosis will help you get the correct treatment. In case of heart problems, early treatment aids in adding years to your life.

Patients diagnosed with erectile dysfunction and are at a higher risk of heart conditions should avoid sexual activity until they are stable. In such cases, your doctor and cardiologist will monitor you closely and advise accordingly.

Besides, various treatment options are available. Let’s have a look at some of the commonly used treatment options.

Oral Medicines

Prescription medicines for ED include:

  • Sildenafil
  • Vardenafil
  • Avanafil
  • Tadalafil

You should also avoid these medicines if you:

  • Take nitrate drugs
  • Have liver or kidney diseases
  • Have an eye disorder known as retinitis pigmentosa
  • Had a stroke or heart attack in the past six months
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However, do not worry, even if pills are not an option for you. There are other treatment options, as well.

Other Treatment Options

Some other common treatment options include:

  • Penis suppository
  • Injections
  • Vacuum pump
  • Testosterone replacement
  • Penile implants
  • Vascular surgery


Along with treatment options, your doctor may suggest lifestyle changes. These lifestyle changes may help prevent ED and keep your heart healthy.

Some precautions include:

  • Increase physical activity
  • Change your diet
  • Drink less alcohol
  • Lose excess weight
  • Quit smoking

These changes help limit damage to blood vessels, which may improve your sexual function and heart health.

Final Thoughts

Erectile dysfunction is a prevalent condition. While erectile problems can be normal at times, such as during stress, it may also be an indicator of an underlying condition.

One such condition is cardiovascular disorders. ED is common in men with heart problems. Both these conditions share causative and risk factors. Controlling these factors with lifestyle modifications will help improve ED and lower the risk of heart disorders.

Prescription medicines are the first-choice treatment for ED and they are effective and safe in the majority of cases. If you have a heart condition and are facing problems in erection, it is best to consult your doctor.

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