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  • Writer's pictureEric Goulder, MD, FACC

Heart Talk - November 2019

Erectile Dysfunction: A red flag for heart attack and stroke risk - and what to do about it

Heart-healthy and Stroke-free Living with Eric A. Goulder, MD, FACC

December 2020 Newsletter for the Heart Attack and Stroke Prevention Center of Central Ohio

Men who struggle with erectile dysfunction (ED) should have their cardiovascular health checked. Compared to men without ED, those who have it are nearly twice as likely to suffer heart attacks, stroke or death from cardiovascular causes, according to a recent study published in Circulation. The increased risk was independent of such traditional risk factors as high cholesterol, smoking and high blood pressure. “Our results reveal that erectile dysfunction is, in and of itself, a potent predictor of cardiovascular risk,” said the study’s lead author, Dr. Michael Blaha.

Dr. Blaha, director of clinical research at Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, advised men with ED to undergo a comprehensive cardiovascular screening. What’s the link between problems in the bedroom and increased heart attack and stroke risk? Here’s a look at the latest discoveries about ED — and the best ways for men who have it to protect their heart and brain health.


Defined as the inability to achieve or maintain an erection firm enough for sex, ED affects up to 57 percent of men in North America, according to a 2019 study published in BJUI International.

After analyzing studies from all over the world, the researchers reported that overall, men with symptoms of impotence were twice as likely to suffer cardiovascular events as those without ED, while severe ED nearly quadrupled risk.

In the U.S., about 620,000 new cases of ED are reported each year — and the annual cost of treatment has been estimated at $330 million. Other studies report that like heart disease, ED becomes more common as men age. About 40 percent of men have erection problems at age 40 and nearly 70 percent at age 70. However, ED is not inevitable as men get older; this condition is both preventable and highly treatable.


Although there are a variety of conditions that can interfere with a man’s sexual performance — including stress, sleep disorders, diabetes, alcohol consumption, smoking, anxiety, depression and the use of certain medications — cardiovascular disease (CVD) is one of the most common culprits, new studies suggest. In September, an analysis pooling the results of studies of more than 150,000 men found that those with ED were 59 percent more likely to have CVD, 34 percent more likely to suffer a stroke and 33 percent more likely to die prematurely.

Commenting on the study, Harvard-affiliated cardiologist Dr. Ron Blankenstein told CNN, “In many cases, [ED] might be the first warning sign of underlying cardiovascular disease.” He compares the penile artery to the proverbial “canary in the coal mine.” This artery, which delivers oxygenated blood to the penis, has a relatively small diameter, he explains: “It’s the smaller blood vessels which show the first signs of disease.” Other research shows that blood-vessel diseases, such as atherosclerosis (plaque buildup in the arteries,) are the underlying cause of about 70 percent of ED cases.

To find out if arterial disease is the root cause of your ED, we recommend a comprehensive cardiovascular evaluation with the BaleDoneen Method, practiced by hundreds of medical and dental providers around the world. This precision medicine, arteriology-based approach is designed to protect and enhance the health of the more than 60,000 miles of blood vessels in your body, including those that supply the heart, brain and sex organs.


The key message from the latest research is that erectile dysfunction is preventable through risk-factor modification. The BaleDoneen Method uses a team approach in which medical and dental providers work together to help patients avoid CVD and its many devastating complications, including heart attacks, strokes, diabetes, heart failure, chronic kidney disease and ED.

Many of the same conditions that cause arterial disease also increase your risk for ED, including smoking, high cholesterol, obstructive sleep apnea, low vitamin D and obesity. Another culprit is periodontal (gum) disease. A recent meta-analysis of studies of more than 500,000 people found that men with this chronic oral infection were at increased risk for ED. The good news, however, is that treating gum disease improved the quality of the men’s erections.

Optimizing your oral wellness can also help you avoid a heart attack or stroke — and protects against dementia. As we recently reported, getting dental care at least twice a year can actually be lifesaving!

Read the Full Newsletter!

Heart Talk - November 2019
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