Cardiovascular (cardiovascular system) diseases are one of the most common health problems today. Lifestyle is extremely important in the emergence of these diseases. The most important aspect of cardiovascular system diseases is the coexistence of erectile dysfunction. Cardiovascular diseases are often manifested by erectile dysfunction. In the investigation of patients who go to urology outpatient clinics with the complaint of ED, it is understood that they have heart and vascular diseases. Likewise, it is seen that some of the male patients who apply to cardiology outpatient clinics have ED complaints. As can be seen, cardiovascular diseases are closely related to erectile dysfunction.

In this article, I will summarize the causes and treatment of cardiovascular diseases and their relationship with ED, taking into account my own observations in the light of the literature.

Erectile dysfunction can be a sign of cardiovascular disease!

Erectile dysfunction (ED) is the absence of an erection or the inability to maintain an erection for adequate intercourse. ED can be an early sign of cardiovascular disease. People with cardiovascular disease may also have erectile dysfunction. These two system diseases are closely related to each other.

Sometimes, cardiovascular system disease can be detected in the investigation of patients who come to the urology doctor with the complaint of ED. Sometimes, patients with cardiovascular disease complaints may have ED complaints. In ED cases caused by trauma, especially in young patients, cardiovascular diseases may not always be present. The causes of these two groups of diseases are also similar. Therefore, it is difficult to consider these two system diseases separately.

Erectile dysfunction complaints are usually present 3-5 years ago in patients with a stent placed on their heart vessels (coronary stent).

What is the relationship between cardiovascular diseases and erectile dysfunction?

Erectile dysfunction begins before heart disease in patients. This is due to the earlier onset of dysfunction in the capillaries in the penis (endothelial cells) and the smooth muscles of the penis. We call this endothelial dysfunction. Endothelial dysfunction causes narrowing of the heart vessels and insufficient blood flow. In this way, endothelial damage and narrowing of the vessels lead to hardening of the arteries called atherosclerosis. Likewise, with the narrowing of the penile vessels, the blood flow to the penis decreases and erection problem (erectile dysfunction) develops. That’s why we say “endothelial dysfunction = erectile dysfunction, ED = ED”.

As a result of endothelial dysfunction, the production of nitric oxide (NO) released from endothelial cells decreases. Since NO is responsible for the enlargement of the vessels and blood supply to the penis, erectile dysfunction develops as a result of its insufficiency. Cholesterol plaques (atheroma plaques) form in the vessels as a result of developing endothelial dysfunction. The result of this is narrowing of both the heart vessels and penile vessels. Eventually, heart disease and erection problems occur.

In cardiovascular diseases, there is a narrowing in the arteries that carry clean blood to the penis, and as a result, not enough blood can reach the penis. If penile color Doppler USG is requested due to erectile dysfunction, if there is narrowing of the penile vessels, these patients usually also have cardiovascular disease. In addition, in these patients, the blood coming to the penis should remain in the penis for a certain period of time. This occurs with the closure of the veins. In cardiovascular diseases, the closure function of the veins of the penis may also be impaired. In short, these patients may have both arterial and venous insufficiency.

The main conditions that cause endothelial dysfunction are:

• Diabetes
• High blood pressure
• Excessive smoking
• Excessive alcohol use
• Obesity
• Still life
• Advanced age

What are cardiovascular system/cardiovascular diseases?

Cardiovascular diseases are one of the most common diseases in the world. Every year, up to 18 million people die from these diseases. Cardiovascular diseases are the general name for diseases of the cardiovascular system. These diseases include diseases such as coronary heart diseases, cerebrovascular diseases, heart diseases due to rheumatic diseases.

The most common cardiovascular diseases are:

• Unstable angina
• Coronary artery disease (narrowing of the heart vessels)
• Myocardial infarction
• Heart failure
• Arrhythmia (heart rhythm disorders)
• Heart valve diseases
• Heart muscle diseases (cardiomyopathy)
• High blood pressure disease
• Peripheral vascular diseases
• Deep vein thrombosis
• Pulmonary embolism
• Aortic diseases
• Marfan syndrome
• Congenital heart diseases
• Some genetic heart diseases
• Having a stroke

Cardiovascular and Erection problem are caused by similar diseases!

Many of the causes of cardiovascular diseases and erectile dysfunction show similarities. We can list the important factors that cause both cardiovascular diseases and erection problems as follows.

• Diabetes
• Smoking
• Alcohol use
• High cholesterol
• High blood pressure
• Advanced age
• Excess weight (obesity)
• Hypogonadism (low testosterone hormone)
• A still life
• Unhealthy eating
• A stressful life
• Advanced age

How should we be protected against cardiovascular diseases and erectile dysfunction?

Prevention methods are similar in patients with cardiovascular diseases and erectile dysfunction. Since the risk factors for both diseases are similar, the principles of prevention are also similar. The prevention methods that patients should pay attention to in patients with cardiovascular diseases and erectile dysfunction are as follows:

• If there is diabetes, control of sugar with appropriate treatment and diet
• Patients who smoke should quit their habits.
• Alcohol use
• If there is high cholesterol, treatment with diet, exercise and medication if necessary
• If there is high blood pressure, bringing it to normal levels
• Appropriate treatment for elderly patients
• Reaching the ideal weight of patients with excess weight (obesity) problem
• If there is hypogonadism (low testosterone hormone), its treatment
• Patients with a sedentary life start a regular exercise program
• Having a balanced and healthy diet if there is an unhealthy diet problem
• Patients with a stressful life should have a more comfortable, stress-free life.
• A regular sleep schedule

Can those with cardiovascular disease use erectile dysfunction drugs?

Cardiovascular diseases may not always give serious symptoms. Male patients aged 40-50 may not always have complaints such as shortness of breath and chest pain while moving. In studies, occlusion of the heart vessels may be observed in these patients, and therefore coronary stenting may be required.

If there are serious cardiovascular diseases, these patients should be evaluated by the relevant specialist. There is no serious problem in using drugs used in the treatment of erectile dysfunction in patients who do not have serious complaints such as shortness of breath and chest pain. We recommend that this group of drugs be used as a result of a urologist examination and not randomly.

Treatment in patients with cardiovascular disease and erectile dysfunction!

A systematic treatment approach is required in the treatment of patients with cardiovascular disease and erectile dysfunction. We can list the treatment principles in these patients as follows:

• Lifestyle changes: These patients need to change their lifestyles and pay attentio to their nutrition.
• Stop drinking alcohol: Alcohol is an important factor in these diseases. Those who drink excessively should definitely quit these habits.
• Stop smoking: Smoking is a serious problem for those with cardiovascular diseases and erectile dysfunction. This is a very important factor in the emergence of diseases. Smoking must be stopped during treatment.
• Weight loss: Obesity is an important health problem. Patients with cardiovascular diseases and erectile dysfunction must reach their ideal weight. Diet and exercise are important. If necessary, bariatric surgery (obesity surgery) should be performed on these patients.
• Regular exercise: A sedentary life causes serious health problems. Regular exercise is very important in the treatment of both cardiovascular and erectile dysfunction.
• Coping with stress: Stress management is important. If necessary, patients should seek support from the relevant specialist.
• High cholesterol treatment: These patients may have high blood cholesterol. This needs to be brought back to normal levels.
• Blood sugar regulation: This group of patients often also has diabetes. Sugar control is important in the treatment of both groups of diseases.
• Treatment of high blood pressure: These patients usually have hypertension. Hypertension must be treated.
• Testosterone therapy: If these patients have testosterone deficiency (hypogonadism), they should be administered. PDE5i treatment can also be given together.
• PDE5i group drugs: Drugs used in the treatment of erection can also be used in patients with cardiovascular disease. These must be used with the recommendation of a doctor.
• Penile vacuum therapy: It is a treatment that can be recommended to suitable patients. It has no side effects.
• Stem cell therapy: It is still in the trial phase. It can be tried in appropriate patients after certain permissions are obtained.
• ESWT treatment: It is an option for eligible patients. It is an effective treatment method with no side effects. We also apply it to our patients.
• Penile injection therapy: Penile injection therapy is a treatment method we apply to patients who do not get enough benefit from oral pills. The drugs used for this purpose are applied to the penis with special needles to provide an erection and the patients have normal intercourse.
• Penile prosthesis surgery: The last treatment option in patients with erectile dysfunction is penile prosthesis insertion. If patients do not respond to current treatments, penile prosthesis should be considered as a last resort.

Can PDE5i group drugs be used comfortably in patients with cardiovascular disease and erectile dysfunction?

PDE5i group drugs are drugs commonly used in the treatment of erectile dysfunction. These increase blood flow to the penis by dilating the blood vessels of the penis. At the same time, these drugs are also useful in general, since they also dilate other normal vessels. However, the use of these drugs must be under the supervision of a doctor.

PDE5i group drugs are drugs used as the first step in the treatment of ED. The most commonly used drugs for this purpose: Sildenafil (viagra), tadalafil (Cialis, Hardcis), Vardenafil (Levitra) and avanafil (Stendra).

PDE5i group drugs can be used without any problems in patients with stable heart disease who do not take nitroglycerin drugs. It is not appropriate for patients taking nitroglycerin to take PDE5i group oral erection drugs. Taking these drugs together can cause severe low blood pressure and fainting.

Summary: Cardiovascular diseases and erectile dysfunction have common risk factors. The methods of prevention of both diseases are similar. Treatment is planned according to the patient. Heart patients should definitely use the drugs used in the treatment of erection with the recommendation of a Urologist and, if necessary, a Cardiologist. PDE5i group drugs do not pose a serious risk in patients who do not have serious heart disease and do not take nitroglycerin. The last procedure to be done in patients who do not respond to current treatments is penile prosthesis surgery.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul- TURKEY