Erectile dysfunction or erectile dysfunction (ED) is defined as the deterioration in the ability of men to initiate and maintain an erection necessary for sexual intercourse. This condition, which is frequently encountered in society, can negatively affect both individual quality of life and couples’ relationships. However, erectile dysfunction should not be considered only as a sexual health problem. Scientific research conducted in recent years has revealed that the inability to achieve an erection is usually a symptom of a health problem and is closely related to cardiovascular diseases (CVD).
Frequency of Erectile Dysfunction
Erectile dysfunction is a problem that affects millions of men worldwide. According to studies, the frequency of occurrence in men over the age of 40 is around 40% and this rate increases with age. For example, this rate can increase to 70% in men over the age of 70. This high rate is associated not only with aging, but also with risk factors such as diabetes, hypertension, obesity, dyslipidemia and smoking. These risk factors are also the main determinants of cardiovascular diseases.
A Brief Overview of Cardiovascular Diseases
Cardiovascular diseases are one of the main causes of morbidity and mortality worldwide. Atherosclerosis is the most common pathophysiological mechanism of cardiovascular diseases and is characterized by fatty accumulation in the arteries, inflammation, and hardening of the vascular wall. It usually occurs as a result of a process that progresses over years, with clinical consequences such as coronary artery disease, peripheral artery disease, and stroke. In this process, it is important to identify and manage risk factors early.
Common Pathophysiology Between Erectile Dysfunction and Cardiovascular Diseases
Erectile dysfunction and cardiovascular diseases have a common pathophysiological basis. These mechanisms are as follows:
a) Endothelial Dysfunction
The endothelium is a layer of cells lining the inner surface of blood vessels and plays a critical role in regulating vascular tone, blood flow, and vascular homeostasis. In both erectile dysfunction and cardiovascular disease, endothelial dysfunction is the fundamental pathological process. Endothelial dysfunction leads to decreased nitric oxide (NO) production. NO is essential for maintaining both erection and cardiovascular health. Decreased NO levels can cause both narrowing of blood vessels and loss of erectile function.
b) Atherosclerosis
Atherosclerosis causes arteries to narrow and lose flexibility. Because penile arteries are smaller in diameter than coronary arteries, the early effects of atherosclerosis may first appear as erectile dysfunction. Therefore, erectile dysfunction may be an early warning signal of cardiovascular disease.
c) Low-Grade Systemic Inflammation
Chronic inflammation plays an important role in both erectile dysfunction and cardiovascular disease. Inflammatory biomarkers (e.g., C-reactive protein) have been associated with an increased risk of both vascular disease and erectile dysfunction.
d) Hormonal Disorders
Low testosterone levels are linked to both erectile dysfunction and cardiovascular health. Testosterone plays a role in maintaining vascular endothelial function and NO synthesis. Additionally, low testosterone levels are associated with cardiovascular disease risk factors such as dyslipidemia, insulin resistance, and obesity.
Is Erectile Dysfunction an Early Warning Signal for Cardiovascular Disease?
Erectile dysfunction can often be the first clinical sign of cardiovascular disease. This is because the penile arteries are smaller in diameter than the coronary arteries. As the atherosclerotic process progresses, narrowing occurs in the smaller penile arteries before the larger arteries are affected. This suggests that erectile dysfunction can be seen 2-5 years before the development of cardiovascular disease. This “window period” provides an important opportunity for early intervention.
Diagnosis and Evaluation
Due to the strong relationship between erectile dysfunction and cardiovascular disease, it is recommended that patients with erectile dysfunction be carefully evaluated for cardiovascular risk. The diagnostic approach may include the following elements:
a) Patient History
The patient’s sexual history, risk factors, lifestyle habits, and current medical condition should be evaluated in detail.
b) Physical Examination
Evaluation of the cardiovascular system includes blood pressure measurement, detection of abdominal obesity, and penile examination.
c) Laboratory Tests
Measurement of blood sugar, lipid profile, testosterone levels, and inflammatory markers is recommended.
d) Cardiovascular Tests
Advanced cardiovascular assessment methods such as stress testing or echocardiography may be used in high-risk individuals with erectile dysfunction.
Treatment Approaches
Erectile dysfunction and Treatment of cardiovascular disease requires targeting the common pathophysiological basis of both conditions. Treatment strategies include:
a) Lifestyle Changes
• Diet: Healthy eating patterns, such as the Mediterranean diet, may help both improve erectile function and reduce the risk of vascular disease.
• Exercise: Regular physical activity improves vascular function and reduces the risk factors for both erectile dysfunction and cardiovascular disease.
• Smoking and Alcohol: Quitting smoking and limiting alcohol consumption are important.
b) Pharmacological Treatment
• PDE-5 Inhibitors: Drugs such as sildenafil and tadalafil are effective in treating ED and may also improve vascular function. However, these drugs should be evaluated carefully in patients taking nitrates.
• Statins: Used to treat dyslipidemia and reduce cardiovascular risk.
• Antihypertensive Drugs: Controlling blood pressure is important in the management of both erectile dysfunction and CVD.
c) Psychological Support
The psychological aspects of erectile dysfunction should not be ignored. Anxiety and depression can be both a cause and a result of erectile dysfunction. Psychotherapy or counseling can be helpful in this regard.
d) Testosterone Replacement Therapy
In patients with low testosterone levels, careful testosterone replacement therapy can improve erectile function as well as cardiovascular health.
e) Penile Regenerative Therapies
These treatments have become quite popular in recent years for treating erectile dysfunction. They include low-intensity (Li-SWT) shock wave therapy, p-shot therapy, exosomes, and mesenchymal stem cell therapy called SVF.
Conclusion
Erectile dysfunction is not only a sexual health problem, but can also be an early sign of cardiovascular disease. The common pathophysiological processes between erectile dysfunction and vascular disease suggest that these two conditions should be evaluated simultaneously. Careful evaluation of patients with erectile dysfunction for cardiovascular risk is critical to both prolonging life and improving quality of life.
The negative effects of erectile dysfunction and vascular disease can be minimized with early diagnosis, lifestyle changes, and appropriate treatment approaches. In this context, it is important for individuals not to hesitate to consult health professionals and to undergo a comprehensive evaluation process.
