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Why erectile dysfunction in your 40s could be a sign of future heart problems

Can cholesterol plaques – the same artery-clogging stuff in your heart – be causing trouble for gentlemen down there?

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The topic of erectile dysfunction isn’t something most men would like to openly talk about. After all, the fact that there’s a chance that things aren’t, well, rising to the occasion in the bedroom, can be a source of embarrassment for some.

But as it turns out, that’s not the only reason more men should be looking at this issue more seriously – because it could also be an indication of heart problems.

For instance, atherosclerosis – or the build-up of cholesterol plaque in the arteries – accounts for 50 per cent to 60 per cent of erectile dysfunction in men over age 60, according to Dr Sriram Narayanan, senior consultant vascular and endovascular surgeon from The Harley Street Heart and Vascular Centre at Gleneagles Hospital.

In fact, he noted that erectile dysfunction can occur approximately three years before a heart attack.

And if you think you’re way too young to even think about these things, you could be wrong. According to The Journal of Urology, the prevalence of erectile dysfunction is about 40 per cent in men in their 40s.

Anecdotally, urologist Dr Ronny Tan from Mount Elizabeth Hospital and Parkway East Hospital, added: “In my practice, I am seeing more and more younger men presenting with erectile dysfunction.”

Senior consultant cardiologist Dr Rohit Khurana, also from The Harley Street Heart and Vascular Centre, agreed that the two conditions are linked.

“There is good evidence that erectile dysfunction is the canary in the coal mine, meaning there is a higher risk of future cardiac events, stroke and mortality when erectile dysfunction occurs in younger men compared with older men.”

(Photo: pixabay/qimono)


How are the heart and penis linked? Think about an erection as a hydraulic event, said Dr Narayanan. “Extra blood must be pumped to the penis, remain in there for some time, and then drain away. If something interferes with the blood flow into the penis or if blood drains away too quickly, it can cause a weak erection that may not last for very long.”

The “interference” that Dr Narayanan mentioned is very commonly caused by the accumulation of plaque in your arteries or atherosclerosis. “Blockages in the blood vessels are actually the leading cause of erectile dysfunction, accounting for about 50 per cent of all cases,” he said.

And it doesn’t only affect down there. Atherosclerosis affects all the arteries in the body, not just the ones in the heart. “For example, plaque build-up in the arteries supplying the brain can cause memory loss, dementia or stroke, while blockages in the arteries supplying the kidneys lead to chronic kidney disease,” he said.

So why is your plumbing the first to take the hit? This is because endothelial dysfunction, the first stage of atherosclerosis, manifests in the smaller arteries of the penis first. “Coronary arteries are 3mm to 4mm in diameter, while the penile artery is 1mm to 2mm in diameter,” said Dr Khurana.

Endothelial dysfunction occurs when the endothelium, the inner lining of the blood vessels, isn’t able to function properly and inhibits blood vessels from dilating properly – which impairs blood flow to the penis.

“Endothelial dysfunction and plaque burden in the small arteries may cause symptoms of erectile dysfunction before they affect blood flow in the large arteries,” said Dr Khurana.


Right off the bat, what doesn’t define erectile dysfunction is the duration of time the penis should stay erect, said Dr Narayanan.

If you don’t recall your biology lessons, here’s how an erection occurs: During arousal, blood flows into a pair of spongy tissue in the penis known as the corporal bodies, explained Dr Tan, which increases the penis’ girth and length. “With sufficient blood in this tissue, the outflow of blood from the penis will be blocked, resulting in an erection that makes the penis turgid enough for penetrative sex.”

The above vascular explanation aside, hormones also play a role. “The surge in testosterone levels in the morning explains why men wake up with ‘morning wood’,” said Dr Tan, so the loss of morning erections, along with a reduced libido, are signs of testosterone deficiency.

Vascular factors are the most common organic causes of erectile dysfunction. This is followed by neurogenic (nerves), hormonal, pharmacological (such as medications for hair growth, antidepressants, muscle relaxants, antihistamines and opioid painkillers) and psychogenic (including stress, anxiety, depression and mental health disorders).

Medical conditions such as Parkinson’s disease, multiple sclerosis and Peyronie’s disease can also lead to dissatisfaction in the bedroom.

(Photo: Freepik/pch.vector)


Experiencing erectile dysfunction in your 40s could be a sign of premature vascular ageing, noted Dr Khurana. It is advisable for you to undergo a cardiovascular risk screen as the issue may be the initial sign of any increased risk of heart disease and especially diabetes, he said.

Dr Narayanan added that men should also speak to their doctor if, in addition to erectile dysfunction, they also experience other heart disease symptoms, including shortness of breath, chest pain or angina, or heart palpitations.

A thorough interview or questionnaire as well as a physical test are first and foremost to identify any possible lifestyle or psychological causes, said Dr Narayanan. “The patient will be asked a lot of questions about his erections. For example, do you get erections but lose them quickly? Do you wake with morning erections? Can you achieve them when alone but not with your partner, and so on.”

In addition to blood tests and X-rays, cardiovascular screening tests, which could include an electrocardiogram (ECG), treadmill exercise test and/or a carotid duplex test (which is an ultrasound test), may be ordered by your doctor.


When it comes to cutting your cardiovascular risks and improving erectile function, the same ol' adage applies: Exercise, eat a healthy diet, lose weight and stop smoking. Moreover, these lifestyle changes are necessary for the medicine to work if you’ve been prescribed anti-hypertensive, cholesterol and anti-platelet medications for your heart health, said Dr Khurana.

Although erectile dysfunction medications are safe for healthy patients, those with pre-existing cardiovascular disease should take care not to mix them, said Dr Narayanan.

This is owing to the artery-widening effect that erectile dysfunction medication has, which can cause blood pressure to temporarily drop. If you are also prescribed a class of drugs called nitrates to open blocked arteries and manage angina, your blood pressure may drop to dangerously low levels, said Dr Narayanan.

“As a result of these concerns, the US Food and Drug Administration has cautioned against erectile dysfunction pill use in male patients who have been treated for heart attacks, strokes or heart rhythm disturbances in the last six months.”

Other than medication, stents are another method doctors use to treat blockages in both the heart and penile arteries. You may have heard about these straw-like implants inserted into previously blocked arteries to keep them from narrowing again. The same principle can be applied to the arteries in the penis and both are day-surgery procedures, said Dr Narayanan.

“According to the International Society for Sexual Medicine, although pelvic artery stents have proven to be effective, they are not suitable for all men,” he said. “The procedure is also fairly new so more research is needed to determine its long-term efficacy.”


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