Sexual Health Q&A

What is the link between erectile dysfunction (ED) and coronary artery disease?

Coronary artery disease (CAD) a common type of heart disease. It is marked by atherosclerosis or “hardening of the arteries.” When a person has atherosclerosis, cholesterol and other substances build up on the walls of the arteries, making them narrower. This makes it more difficult for blood to flow through the arteries. Severe atherosclerosis can lead to dangerous situations like heart attacks and strokes.

Atherosclerosis can cause problems with erections, too. This is because proper blood flow to the penis is essential for good erections. When a man becomes sexually aroused, his penis fills with blood, giving it the rigidity it needs for intercourse. After he ejaculates, this blood flows back into the body.

If a man’s arteries are clogged, less blood can flow to the penis. As a result, his erection may not be firm enough for sex. Or, he might not be able to have an erection at all.

ED is often a signal that a man could have coronary artery disease. Some experts estimate that ED could precede a CAD diagnosis by two to five years. Because they are so small, penile arteries are often the first to become blocked.

The link between ED and CAD is especially significant for men under age 60 who do not have apparent risk factors for heart disease, such as hypertension (high blood pressure) or heart failure. 

Many men are reluctant to discuss ED with a healthcare provider. However, it’s important for men with ED to be checked for CAD. Doctors can determine whether other arteries, such as those closer to the heart or brain, are affected by atherosclerosis.  Also, a simple electrocardiogram (ECG) or stress ECG can provide important information about a patient’s heart condition.

Treating CAD at this point can help prevent future problems and it may improve erections as well. Sometimes, all men have to do is eat a healthier diet, exercise more, or stop smoking.

Treatments for ED are also possible, but they do not stop atherosclerosis or prevent CAD. Men who take nitrates to treat heart disease cannot take certain ED medications because dangerous drug interactions could occur.