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School of Medicine
Special Heart Risks for Men
Men tend to develop coronary artery disease earlier than women. Some warning signs of heart disease, like erectile dysfunction, can start especially early. Here’s what men should know.
Men develop heart disease 10 years earlier, on average, than women do. They also have an early warning sign that few can miss: erectile dysfunction (ED). “It’s the canary in the coal mine,” says a Johns Hopkins expert. “Sexual problems often foretell heart problems.”
On the plus side, any risk factor—even ED—that gets your attention can put you on a path to better preventive care.
Heart Risk Factor: Erectile Dysfunction
“A lot of people think erectile dysfunction is the inability to get an erection at all, but an early sign of the condition is not being able to maintain an erection long enough to have satisfactory sexual intercourse,” says a Johns Hopkins expert. Erectile problems aren’t a normal part of getting older as many people think; rather, they almost always indicate a physical problem.
A key reason erectile dysfunction is considered a barometer for overall cardiovascular health is that the penis, like the heart, is a vascular organ. Because its arteries are much smaller than the heart’s, arterial damage shows up there first—often years ahead of heart disease symptoms. Men in their 40s who have erection problems (but no other risk factors for cardiovascular disease) run an 80 percent risk of developing heart problems within 10 years.
Treatment tends to be successful when started as soon as you begin to notice erection problems over more than a couple of months. An ED workup by a doctor will address heart disease risk factors, such as prediabetes, high blood pressure or excess weight — hopefully, long before they result in a heart attack or stroke.
Heart Risk Factor: Low Testosterone
Having a low testosterone level is often thought of as just a diminished sex drive, but it’s increasingly seen as being linked to heart disease and type 2 diabetes, the expert says. He notes that a growing body of research indicates that “low T” can be considered a cardiovascular and metabolic risk factor.
“These ideas are still being studied, but we know, for example, that people with abdominal obesity [so-called ‘belly fat’] or metabolic syndrome often have low testosterone,” the expert says. Metabolic syndrome (which includes high blood sugar levels, unhealthy cholesterol levels, and too much weight in the midsection) and diabetes are leading risk factors for heart disease.
Low testosterone is simply one part of an overall picture of heart risk, the expert says. But it can be motivating, even lifesaving, to know that changes in your sexual function are closely interrelated to the rest of your body. It’s worthwhile to get yourself checked out when something doesn’t seem right. “Men often don’t connect this problem to or get evaluated for stroke or heart attack risk until it happens,” he says. “But sexual problems are a message they listen to.”
Heart Risk Factor: Stress
Stress, anger and anxiety raise levels of blood pressure and stress hormones, and they can restrict blood flow to the heart. Some damage can be immediate. In the two hours after an angry outburst, for example, your risk of a heart attack is nearly five times greater and your risk of stroke three times higher, research has shown.
What’s more, the effects of chronic stress can build over time, damaging arteries. Men who have angry or hostile personalities, in particular, have a higher risk of developing heart disease. Sexual problems related to heart disease can cause added anxiety or relationship stress. Stress can also affect sleep, which in turn affects heart health.
“Physical, emotional and psychological factors are all related when it comes to heart health,” says a Johns Hopkins expert. “When someone has chronic stress, depression or anxiety, they should have a basic evaluation of all of the risk factors for heart disease.”