In 2024, around 4 million men are living with cardiovascular disease and around 4.3 million men are suffering from erectile dysfunction (ED) in the UK. [1,2] Many people suffer from both conditions, making seeking a treatment for erectile dysfunction more complicated.
In this article, we explore the link between erectile dysfunction and heart disease, who can and cannot take ED medication, safe ED treatments for people with health problems and more.
Before you determine which treatments you can take for erectile dysfunction if you have a pre-existing heart problem, you need to understand if there is a link between the two conditions. In the last decade, experts have discovered some links between erectile dysfunction and heart disease. Firstly, both conditions share similar risk factors such as age, obesity, diabetes, smoking, high blood pressure, high cholesterol and poor lifestyle. These common risk factors contribute to restricting blood flow, affecting the heart and erectile performance.
Secondly, erectile dysfunction can be an early sign of cardiovascular disease. During an erection, blood is carried to the penis through the arteries. Since the arteries in the penis are far thinner than those leading to the heart or brain, a buildup of plaque in these arteries (atherosclerosis) can limit or block blood flow to the penis, making it difficult to get or maintain an erection. As a result, erectile dysfunction can help to detect an early diagnosis before it can develop into serious heart problems such as coronary heart disease and heart attacks. [3]
As cardiovascular disease can restrict blood to other parts of the body including the penis, it is one of the causes of erectile dysfunction.
One of the most effective ways to treat erectile dysfunction is by taking a type of medication called phosphodiesterase-5 (PDE5) inhibitors. These medications work by relaxing the blood vessels and increasing blood flow to the penis, leading to a firm and long-lasting erection.
Curiously, PDE5 inhibitors were originally developed to treat other conditions such as pulmonary hypertension and angina pectoris before they showed a significant impact in improving erectile performance. For people with heart problems, the use of PDE5 inhibitors must be considered carefully. These medications work on the blood vessels not only in the penis but also throughout the body.
While PDE5 inhibitors are effective in treating erectile dysfunction for most people, they are not suitable for everyone. Patients should avoid taking PDE5 inhibitors if they have the following heart conditions [4]:
In addition, patients who are taking nitrates (a medication for treating angina) should also avoid taking PDE5 inhibitors. We will discuss the reason for this later on.
If your heart condition is stable, you may get oral medication prescribed by your doctor to treat erectile dysfunction. Sildenafil and Viagra are two types of PDE5 inhibitors that are often prescribed for mild to moderate cases of erectile dysfunction. Your doctor can evaluate whether or not you can take ED medication depending on the type of heart condition you have, the severity of it, your lifestyle, medical history, current medications and other factors.
For those who can’t take PDE5 inhibitors, there are alternatives to oral ED medications for treating erectile dysfunction:
It’s also essential to engage in honest discussions with your partner about erectile dysfunction and its links to cardiovascular health. Starting the initial conversation may be difficult at first, but it is a vital part of creating a supportive environment at home, both physically and emotionally. Involving your partner can also help to mitigate feelings of isolation, confusion, or misplaced guilt that might arise.
If you are taking certain heart medications, you may have to avoid taking oral ED medication. PDE5 inhibitors must not be used by those taking nitrate-based medicines, riociguat or nitric oxide donors such as amyl nitrite (also known as poppers). A combination of these medications and PDE5 inhibitors could cause a dangerous drop in blood pressure. [5] If you are taking other heart medications, read the product information leaflet and discuss it with your doctor or cardiologist before taking any ED medication.
If it’s safe to do so under medical supervision, PDE5 inhibitors should be taken at least 12 hours before using a GTN spray or at least 24 hours before taking nitrate tablets. [3]
Viagra is a popular brand of Sildenafil, which is available through a prescription. Like all medications, Viagra can have benefits and risks. It has been used for many years in treating erectile dysfunction. While it is relatively safe and beneficial for healthy individuals, it carries significant risks for individuals with heart problems. Serious side effects include heart palpitations and high or low blood pressure and angina, increasing the risk of a heart attack.
Some studies have shown that PDE5 inhibitors can be beneficial after a heart attack. A 2017 study which tracked more than 43,000 men for an average of 3.3 years, found that men prescribed PDE5 inhibitors after their first heart attack were less likely to die or be hospitalised for heart failure than men who didn’t take the drug. [6]
If you recently had a heart attack, it is common to experience erectile dysfunction during recovery. This often happens due to anxiety or it can be a side effect of certain heart medications. It is not advised to take ED medication after a recent heart attack. It can take at least 6 months after a heart attack before you can be prescribed ED medication by your doctor, providing your condition is stable.
After heart surgery, it can take several weeks or months before you can resume normal sexual activity. Once recovered, some individuals often find it difficult to achieve or maintain an erection. If you have undergone heart surgery and are considering ED medication, consult with your doctor or cardiologist first.
Some recent studies suggest that heart stents coated with Sildenafil or Viagra may prevent blood clots and the narrowing of arteries [7]. Whether or not you can safely take ED medication depends on your heart condition, the specific heart surgery you had, the types of medications you are taking and other factors.
British Health Foundation. (2024). UK Factsheet. Retrieved 15th October 2024, from: https://www.bhf.org.uk/-/media/files/for-professionals/research/heart-statistics/bhf-cvd-statistics-uk-factsheet.pdf
The Urology Foundation. (2024). Erectile Dysfunction. Retrieved 15th October 2024, from: https://www.theurologyfoundation.org/urology-health/male-reproductive-organs-conditions/erectile-dysfunction/
British Health Foundation. (n.d). Let’s Talk About... Erectile Dysfunction. Retrieved 15th October 2024, from: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/wellbeing/erectile-dysfunction
National Institute for Health and Care Excellence (NICE). (2024). Phosphodiesterase-5 (PDE-5) Inhibitors. Retrieved 15th October 2024, from: https://cks.nice.org.uk/topics/erectile-dysfunction/prescribing-information/phosphodiesterase-5-pde-5-inhibitors/
EMC. (2023). Packet Leaflet: Sildenafil 25 mg, 50 mg and 100 mg Film-Coated Tablets. Retrieved 15th October 2024, from: https://www.medicines.org.uk/emc/files/pil.3172.pdf
American College of Cardiology (2017). Erectile Dysfunction Drugs Are Safe, Possibly Beneficial After Heart Attack. Retrieved 15th October 2024, from: https://www.acc.org/about-acc/press-releases/2017/03/09/14/25/erectile-dysfunction-drugs-are-safe-possibly-beneficial-after-heart-attack
Medical News Today. (2017). Viagra May Reduce Blood Clots After Stent Surgery. Retrieved 15th October 2024, from: https://www.medicalnewstoday.com/articles/318341
Whilst all of our content is written and reviewed by healthcare professionals, it is not intended to be substituted for or used as medical advice. If you have any questions or concerns about your health, please speak to your doctor.
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