The penis as risk marker

While earlier studies suggested connections between severe erectile dysfunction and heart attacks and strokes, new research conducted by scientists in Australia and published in the journal "PLOS Medicine" is the first to show links with mild moderately severe erection problems. DW spoke to the study's lead author, professor Emily Banks of the Australian National University, about investigating the links between erectile dysfunction and cardiovascular disease.

DW: How did you conduct this research and what were your findings?

Emily Banks: Over 95,000 men, participating in the Sax Institute's 45-and-up study, filled in a questionnaire about their health and lifestyle, including questions about their ability to get and maintain an erection. We followed those men forward over time and over the following two or three years we found that men who had severe erectile dysfunction had around a 60 percent increase in their risk of going to hospital for coronary artery disease, and around double the risk of dying, compared to men who had no problems getting an erection.

The bottom line for men is that if you are having problems getting an erection, even if they are relatively minor at this point, now would be a good time to take action and go to your general practitioner or another health professional and have a heart check because what we're finding is that erectile dysfunction has this ability to predict the risk of cardiovascular disease over and above traditional risk factors. We found this increased risk in men with erectile dysfunction compared to those without, even after we had adjusted for things like smoking, diabetes, a person's body mass index, how much exercise they got, and it was over and above those traditional risk factors.

Risk marker

First, what sort of an indicator is erectile dysfunction in precise terms - are we talking about an immediate risk of cardiovascular issues, or is it something that could be coming down the line?

What we think is that because the arteries in the penis are smaller than in the heart or the brain, and they're more sensitive to problems with the lining of the blood vessels, that it can actually serve as a kind of early warning system. What we were looking at was the immediate risk of going to hospital. It wasn't about following someone up for tens years and saying somewhere in the distance you're going to develop disease. We actually looked at it in relation to the risk in the two years after we had asked the question about erectile dysfunction.

It's really what we'd call a risk marker - it's something which gives us an idea about the underlying health of the cardiovascular system, and, in fact, it has been termed "the canary in the trousers" - like the canary in the coalmine, it's an early warning system for men.

You mentioned that there are obviously other risk factors, so how do you adjust for those other things? Because erectile dysfunction can be caused by a number of things?

That's right. Erectile dysfunction has a wide range of causes and they include neurological factors, hormonal factors, and psychological factors. But the prevailing view is that erectile dysfunction is probably caused by underlying cardiovascular disease.

What we did in our study is that we adjusted statistically for these other risk factors, so that when we get to that point of saying men with severe erectile dysfunction have a 60 percent increase in their risk of going to hospital for coronary artery disease during the follow up period, that's after we've accounted statistically for those other factors.

Now, in practice we know that smoking increases the risk of cardiovascular disease and it also increases the risk of erectile dysfunction, so addressing that one risk factor will potentially help both of those things.

But it's embarrassing!

This is, of course, an area of health for men where many men would rather not address. How do you think that your findings can translate into society to get people to take these things more seriously?

I think it can be difficult because it's obviously a sensitive area and it's potentially embarrassing. But what we're saying is that it's not just about men's erectile dysfunction. It's not just about treating that problem. It's actually about getting their heart risk checked out. So, it's another motivator to get men to go to the doctor and get themselves checked out.

We have very effective ways of preventing and managing cardiovascular disease. In most of the Western world we've been incredibly successful and we've got plummeting cardiovascular disease death rates - because we're good at managing them. But it really depends on men going to their doctor and having their blood pressure checked, having their cholesterol done, having their blood sugar looked at, stopping smoking if they need to, and getting regular exercise.

We're thinking that the penis is really giving an indicator of the underlying health of the cardiovascular system, it follows that if you can really manage those cardiovascular risk factors, you should be able to slow the progression of erectile dysfunction as well.                      

Emily Banks is a professor of epidemiology and public health at the Australian National University's College of Medicine, Biology and Environment. Her research was conducted with the Sax Institute, a body that aims to connect researchers with health policy and service delivery agencies in the Australian state of New South Wales.