Cardiovascular disease — a range of conditions affecting the heart and blood vessels — kills one Australian every 13 minutes, the majority of which being men1. Some have little awareness of risk factors or early symptoms of these disorders until they have a cardiovascular event such as a heart attack, angina, stroke or heart failure. But for men there’s a canary in the coal mine, so to speak, that should make you consider whether there’s something amiss with your heart health well before it takes a turn for the worse. It’s erectile dysfunction — difficulty getting or maintaining an erection — a treatable condition that can greatly impact the wellbeing of men and their partners and could indicate cardiovascular disease2,3.
What’s love got to do with it?
A quick explainer on erections — in order to achieve one, three things must occur. The nerves to the penis must be functioning properly, there must be stimulus from the brain, and there must be adequate blood circulation to the penis. When your artery walls get built up with plaque (a process called atherosclerosis) it can restrict blood flow to the heart, brain and — in the case of erectile dysfunction — the penis. It’s the underlying cause of most heart attacks and strokes, beginning years before there are any signs or symptoms. It can also cause vascular erectile dysfunction.
Research published in the journal Circulation4 found that in a study of 1700 men over a four-year period, experiencing erectile dysfunction was linked to a two-fold increase in heart attacks, strokes, and cardiovascular death beyond traditional risk factors.
“Because the penile vessel and the penile artery is smaller, about 1-2 millimetres, erectile dysfunction will present earlier than cardiovascular disease, a stroke or TIA (Transient Ischaemic Attack, a stroke-like attack),” Dr James Navin Richards, GP, says.
In fact, research has found that erectile dysfunction can precede cardiovascular symptoms by two to three years and cardiovascular event, such as a heart attack or stroke, by three to five years5. That’s a canary that’s giving its vocal cords a workout.
Are men missing the connection?
Erectile dysfunction affects one in five men over the age of 40, but Dr Richards says that most men aren’t aware of the connection between the condition and heart health.
“It’s a common issue but they don’t see the connection with heart disease,” he says. “They think of it as an erection issue and don’t think anything else of it. A lot men just get Viagra or over the counter stuff [without looking any further].”
Care is also hindered by men’s reluctance to speak to a GP about erectile dysfunction in the first place, meaning many are missing the opportunity to catch cardiovascular disease early. A survey of nearly 6000 Australia men aged 40 or older found that only 30% of men with moderate to severe erectile dysfunction discussed the issue with a health professional6. Some doctors are also disinclined to broach the problem with patients due to time constraints and their own discomfort.
Our own research indicates that men who had never been married were the least likely to speak to a health professional about erectile dysfunction, while those living in a rural or regional area, or from a non-English speaking background, were less likely to receive treatment for erectile dysfunction compared to other men. However, the link between erectile dysfunction and cardiovascular disease shows that even if you don’t want to have sex, it can still be treated as a barometer of your overall health.
Beating them both
A heart attack shouldn’t be the first step in diagnosing cardiovascular disease or treating erectile dysfunction, and neither conditions need to be ’normal’ parts of ageing. Your GP can help you explore options for improving sexual function and potentially prevent a life-threatening event like a heart attack.
Understanding your risk factors and managing them with the help of your GP is important for leading a heart (and erection) healthy life.
What you can’t change
What you can
 Vlachopoulos C, Ioakeimidis N, Stefanadis C. Biomarkers, erectile dysfunction, and cardiovascular risk prediction: the latest of an evolving concept. Asian J Androl [serial online] 2015 [cited 2020 Nov 20];17:17-20.
 Uddin, S. M. I., Mirbolouk, M., Dardari, Z., Feldman, D. I., Cainzos-Achirica, M., DeFilippis, A. P., Greenland, P., Blankstein, R., Billups, K. L., Miner, M. M., Nasir, K., & Blaha, M. J. (2018). Erectile dysfunction as an independent predictor of future cardiovascular events: The multi-ethnic study of atherosclerosis. Circulation, 138(5), 540-542. https://doi.org/10.1161/CIRCULATIONAHA.118.033990https://doi.org/10.1161/CIRCULATIONAHA.118.033990.
 Hodges LD, Kirby M, Solanki J, O'Donnell J, Brodie DA. The temporal relationship between erectile dysfunction and cardiovascular disease. Int J Clin Pract. 2007 Dec;61(12):2019-25. doi: 10.1111/j.1742-1241.2007.01629.x. PMID: 17997808.
 Holden CA, McLachlan RI, Pitts M, Cumming R, Wittert G, Agius PA, Handelsman DJ, de Kretser DM. Men in Australia Telephone Survey (MATeS): a national survey of the reproductive health and concerns of middle-aged and older Australian men. Lancet. 2005 Jul 16-22;366(9481):218-24. doi: 10.1016/S0140-6736(05)66911-5. PMID: 16023512.