Erectile dysfunction and heart disease share many of the same risk factors and erectile dysfunction is estimated to co-exist with heart disease in 40% of cases.

Heart disease is one of the most common causes of erectile dysfunction. It is normal for men with heart disease to experience erection problems along with changes to their sex drive. In some cases, the drugs used for treating heart disease can cause erectile dysfunction.

Erectile dysfunction can generally be treated in men with stable heart conditions. However all patients with cardiac disease should highlight the condition to their doctor before any treatment is commenced. In addition, medications required to treat heart disease should be discussed as some cannot be given with ED medications.

Known as atherosclerosis, this process narrows the diameter of the artery and impairs blood flow. If a patient is found to have atherosclerosis in any artery, he is likely to have it in many, including those that supply blood to the penis.

Cardiovascular disease is often a result of inadequate physical exercise and a poor diet, high in saturated fat and sodium and low in fruit, vegetables and wholegrains. Risk factors such as diabetes, hypertension, raised cholesterol level, smoking and a high alcohol intake are also likely to contribute. Some people may possess a genetic predisposition to the disease.

Cardiovascular disease can be subdivided into four conditions:

•   Coronary artery disease (CAD)/coronary heart disease (CHD) - disease of the blood vessels that supply the heart
•   Peripheral arterial disease/peripheral ischaemic disease (PID) - disease of the arteries supplying the legs
•   Cerebrovascular disease - disease of the arteries of the brain which can lead to stroke
•   Hypertension or high blood pressure – a disease that contributes to all three of the above.

Erectile dysfunction and CVD
The process of normal erectile function is complex and requires the coordination of various hormones, nerves, vascular and psychological factors. Atherosclerosis which causes CVD is one of the most common erectile dysfunction of ED.

Men are notoriously reticent at seeking help for their health problems, especially when it is something they find embarrassing. However, you should always seek help for ED because it may be the first visible symptom of undiagnosed or hidden cardiovascular disease. Atherosclerosis develops slowly and it may take many years before it causes any cardiovascular symptoms, but because the arteries in the penis are so small, they may be the first affected. This results in an inadequate supply of blood to the penis on sexual stimulation, which reduces the ability to achieve an erection. Identifying and treating ED will not only help to restore a sexual relationship, but may also allow the diagnosis of underlying disease at an earlier stage, improving the outcome of any treatment.

In patients with severe cardiac disease or unstable conditions, sexual activity may not be advisable. Always discuss with your doctor

Treatment of ED in CVD
It is normal for men with cardiovascular disease to notice changes in their erectile function, as well as their sex drive, and some of the drugs used for treating cardiovascular disease may actually cause ED. ED can often be successfully treated in men with cardiovascular disease but first it is essential to ensure the CV disease is stable, a risk assessment has been performed and that concomitant medication has been assessed.

Oral treatments know as phosphodiesterase 5 inhibitors are not suitable for men taking nitrates, for example GTN spray.

Treatment of ED should be tailored to suit the individual and may follow further investigations to fully assess the state of your cardiovascular system. Initial treatment should encompass lifestyle changes, working with the primary health care team, so you can take some responsibility for your own health. Suggestions may include a diet low in saturated fat and sodium while high in fruit, vegetables and wholegrains plus a graduated exercise programme. The GP and nurse can help you further by encouraging you to stop smoking, and by lowering cholesterol and treating cardiovascular diseases such as hypertension and angina, which may all improve erectile function.