But sexual symptoms may also signal problems that go beyond impaired intimacy, according to new research that shows diabetic men who struggle with impotence face twice the risk for potentially deadly heart problems.
In fact, erectile dysfunction can predict cardiovascular troubles that include chest pain, heart attack, stroke — and death, according to two new studies published in the latest issue of the Journal of the American College of Cardiology.
Men with type 2 diabetes can’t afford to ignore the warning, even if it’s embarrassing, said Dr. Peter C.Y. Tong, an associate professor at Prince of Wales Hospital at the Chinese University of Hong Kong, who studied the problem in more than 2,300 Chinese men.
“You must take action NOW to improve upon these modifiable risk factors,” Tong wrote in an e-mail. “Otherwise, you will have a high chance of having a heart attack in the near future.”
Men who have difficulty achieving or maintaining erections should tell their doctors without delay so they can be evaluated for further cardiac risk. Interventions might include changes in diet, exercise or medication, experts said.
Diabetes experts in the U.S. caution that erectile dysfunction is just one of several complications of diabetes that should serve as a warning flag for dangerous cardiovascular problems. But it’s one that may make men take notice, said Dr. John Buse, president of medicine and science for the American Diabetes Association.
“The information is fabulous, in a way, because men tend not to pay attention to long term health care issues,” Buse said, adding: “There’s just a lot of denial.”
Tong’s research studied diabetic men in their mid-50s with no history of heart disease for up to seven years. He found that those with erectile dysfunction were nearly twice as likely to have problems associated with coronary heart disease than those without. Of 616 men with erectile dysfunction, 49, or about 8 percent, suffered cardiac problems such as heart failure, heart attack or stroke, the study showed, compared to 74 out of 1,690 men without ED, or about 4.4 percent.
Taboos could affect results
The results might actually underestimate the true problem, said Tong, who noted that strong taboos about discussing sexual function could have prevented some men from admitting to the condition.
The risk was higher in men with type 2 diabetes who also had a history of coronary heart disease, according to Dr. Carmine Gazzaruso, a specialist at the Beato Matteo Hospital Group in Vigevano, Italy. She was the lead author of a study of 291 men in their mid-50s with a history of silent, or symptomless, coronary artery disease. Her work showed that men with erectile dysfunction were more than twice as likely to suffer heart attacks or strokes.
Of 118 men with erectile dysfunction, 30, or 25 percent, reported a serious cardiac problem over seven years. That compared to 19 of 173 men without impotence, or about 11 percent. Gazzaruso said her study was the first longitudinal study of diabetics with high-risk heart disease.
Erectile dysfunction is a good predictor of heart disease or stroke because both conditions occur when certain arteries fail to expand fully in response to stimulus, Gazzaruso said. Because the arteries in the penis are smaller than those in the heart, for instance, the condition might show up sooner.
But men weighing whether to talk to their doctors shouldn’t think that gives them room to wait, the scientists said. The risk of developing heart disease occurred right from the beginning of the studies, Tong noted.
Gazzaruso’s study also looked at whether drugs used to treat erectile dysfunction, such as Viagra, Cialis and Levitra, might protect against cardiac problems in patients with vascular disorders. Although some improvement was shown, the results might have been due to chance. Long-term controlled studies are needed to measure the effects of those drugs, known as PDE5 inhibitors, Gazzaruso said.
Men aren't eager to talk about it
In the meantime, awareness about the connection between diabetes, erectile dysfunction and heart risks is long overdue, even those familiar with the disease said. Andy Mandell, executive director of the Defeat Diabetes Foundation, said most diabetic men have no idea that erectile dysfunction may signal cardiac problems.
Mandell, who bills himself as “Mr. Diabetes,” has finished more than 9,445 miles of a 10,000-mile walk to raise awareness about the disorder. During his trek around the perimeter of the United States, he’s talked to nearly 60,000 diabetics, and says only a handful of men have ever mentioned the problem.
“It’s not the kind of conversation that people are usually open and up front about,” said Mandell, 63, who was diagnosed with type 2 diabetes in 1985.
Even so, sufferers should speak up — and doctors should take note, said Buse, of the American Diabetes Association.
“Maybe it will make urologists think a little more about why erectile dysfunction is occurring in the first place,” Buse said.