If you have insulin-dependent
diabetes for 50 years or more and are having problems with erection, you might
want to get your heart checked.
A new study at Joslin Diabetes Center, Boston, indicated that a history
of erectile dysfunction is independently associated with cardiovascular disease
in people with type-1 diabetes.
This means that erectile dysfunction can
predict the onset of cardiovascular disease in people who have type-1 diabetes
for 50 or more years.
Erectile dysfunction (ED)
due to inability of penile smooth muscles to relax because of inadequate nitric
oxide. Nitric oxide signals the smooth muscle cells in the blood vessels to
relax and dilate, so that blood flows more freely.
Atherosclerosis is a condition
where blood supply to a particular part is obstructed due to formation of a
plaque in the vessel. Plaque formation
in the heart could lead to a heart attack, whereas plaque formation in the
brain could lead to stroke. The smaller blood vessels in the penis are among
the first to get plugged up in case of atherosclerosis. The plaque reduces
blood flow in the penis, making an erection difficult. So, erectile dysfunction
is an alert to look for plaque in larger arteries supplying the heart and other
"In general, the vessels involved
in erectile dysfunction have a smaller diameter, and tend to be affected
by mechanisms of endothelial dysfunction earlier than larger vessels
found in the heart, so this could be a predictor of cardiovascular disease,"
explained the author Sara Turek, study coordinator for the Medalist program at
Joslin. In Joslin Medalist Program, medals are awarded to people living with
insulin-dependent diabetes for 25, 50, or 75 years or more.
The Joslin study involved
examination of approximately 300 men who completed questionnaires including a
question regarding sexual dysfunction.
Seventy percent of the
participants reported experiencing sexual dysfunction over their lifetime.
The main finding showed that sexual dysfunction is associated with
cardiovascular disease without being mediated by other identified risk factors
Other risk factors for cardiovascular disease associated with diabetes include
high LDL cholesterol levels, low HDL cholesterol levels, elevated body mass
index (BMI), poor glycemic control, high blood pressure, insulin resistance and
a history of smoking.
"If [sexual dysfunction] is an
overt problem that drives a man to go to the doctor, it should clue the doctor
to take a look at some possible cardiovascular symptoms before anything major
and life threatening arises," Turek said.
"The age of this group is interesting," said
co-author Stephanie Hastings. "I think it will become more relevant as
people continue live longer."
The researchers want to expand the study in
future to see if the results are consistent with a larger group of participants
and following up with medalist participants in three or so years to see if
their results have changed or stayed stable.
Turek and Hastings are also curious about exploring
the connection between sexual dysfunction and cardiovascular disease in women.