Prof. Albert Ferro on erectile dysfunction and cardiovascular disease

Take-home points

• Erectile dysfunction is a common sexual health issue in men and is a treatable condition.
• It can also be a symptom of an underlying disease called coronary artery disease.
• Many organisations are calling for erectile dysfunction to be recognised as a valid predictor and screening tool for heart disease.  
• Professor. Albert Ferro emphasises the importance for doctors and nurses to ask their male patients about their erectile function. 

What is erectile dysfunction?

Erectile dysfunction (ED) is a common sexual health issue in men with estimates suggesting that up to 52% of men between the ages of 40 and 70 in the United States struggle with ED.¹ Fortunately, it’s a completely treatable condition with many interventions widely available.  

Like with many conditions, ED can also be a symptom of an underlying disease, in this case, coronary artery disease. ED can precede coronary artery disease by three to five years.^2,3 This has led to numerous organisations, such as The British Society for Sexual Medicine and The European Society of Cardiology, calling for ED to be recognised as a valid predictor and screening tool for heart disease.^2,4  

What is coronary artery disease?

• A condition where the arteries supplying blood to the heart are narrowed or blocked, causing a heart attack or stroke

Using erectile dysfunction as a screening tool for CVD

A world-leading cardiologist and specialist in atherosclerosis (the build-up of fat within the artery walls), Professor. Albert Ferro from Kings College London, sat down with TRTed to discuss why he is screening for ED in his practice.  

• ‘’Something that’s being increasingly recognised is the presence of erectile dysfunction in men as an early predictor of silent atherosclerosis. The thing about atherosclerosis is that it often doesn’t cause any symptoms until it’s in a very advanced stage or even people may present for the first time to medical attention with a heart attack or with a stroke having had no previous symptoms at all. But we now know, actually, that there are subtle things that if you don’t ask about them, you’ll miss them, and erectile dysfunction is certainly one of them.’’  

ED is a condition that many men feel too embarrassed to talk about openly with their friends, family, and doctors. However, Professor. Ferro emphasises why it's important for doctors and nurses to ask their male patients about their erectile function during appointments.  

• ‘’People don’t necessarily talk about it, they don’t necessarily come to their doctor about it, and they won’t necessarily volunteer that information unless you specifically ask about it. But we now know that atherosclerosis can affect the arteries supplying the penis just as well as the other arteries in your body, and because of that it can cause problems with erections, and that can be an early warning of the presence of atherosclerosis elsewhere and an indicator that those patients should be investigated.’’  

For men who are concerned about their erectile function, it’s important to keep in mind that CVD is just one of many possible causes. Though when asked about what men should do if they are concerned they have ED, Professor. Ferro reiterates the importance of visiting your healthcare professional.  

• ‘’To visit your healthcare professional, such as your GP. And I think there’s increasing awareness now of ED as a predictor of silent atherosclerosis and your GP may well refer you to a local specialist who might do further screening and further investigating. The other thing to say about it is we now have very successful and very effective treatments for ED, so even if you haven’t got co-existent heart disease, we can do something about erectile dysfunction.’’  

Diagnosing erectile dysfunction

ED is defined as the persistent inability to attain and/or maintain an erection that is sufficient for sexual performance.⁵ The keyword within this definition is ‘persistent’. If a man occasionally experience a failed erection, it may well be nothing to worry about.³ If it happens more often, then ED could be present; and if so, following the correct diagnostic protocol, such as that from the European Association of Urology, is strongly recommended.⁶  

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References

1. Feldman HA, et al.  Journal of Urology 1994;151(1), 54–61.  

2. Hacket G, et al. J Sex Med 2018;15:430–457.    

3. Montorsi P, et al. Eur Heart J 2006; 27:2632-2639.

4. Visseren FLJ, et al. Eur Heart J 2021;42(34):327–3337.

5. NHS. Erectile dysfunction (impotence) available at: https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/. Date accessed: September 2022.    

6. NHS Inform. Erectile dysfunction (impotence) available at: https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/erectile-dysfunction-impotence. Date accessed: September 2022.

7. NHS. Diagnosis (coronary artery disease) available at: https://www.nhs.uk/conditions/coronary-heart-disease/diagnosis/.