The Link Between Erectile Dysfunction and Heart Failure

Erectile dysfunction (ED) is not an easy topic of discussion for those who experience it. Some people choose to suffer silently rather than tell their physicians what they are experiencing. As a pharmacist, I encounter many customers who are prescribed medications to assist with ED. Some have confided in me of the shame and embarrassment they feel, not realizing how prevalent the condition is. Sex is an important aspect of wellbeing; neglecting it can cause consequences in one's quality of life.

Sexual dysfunction and heart failure

There is a clear correlation between ED and heart failure. ED is higher in men who have heart disease than men with no heart complications. This is because of the overlapping risk factors of the two conditions.¹ Having heart disease increases the risk of erectile dysfunction, and having erectile dysfunction may be an early sign of heart disease.¹

Offensive drugs

ED can be effectively managed - and that is why it is important to seek help! Before treatment is discussed, it is important to make sure that there are no external factors worsening sexual function. In fact, medications are the culprit in 25% of ED cases.²

Some offensive drugs include:

• Thiazide diuretics, such as hydrochlorothiazide, or chlorthalidone
• Spironolactone
• Antidepressants
• Some beta-blockers

People with heart failure may be on some of these drugs. However, this doesn't necessarily imply that these drugs should be discontinued. For example, an alternative can be prescribed or a dose reduction may be suitable.

ED drugs

If the causes of ED are ruled out, then a doctor may recommend medications to help improve function. The most common class of medications used to treat ED are the PDE-5 inhibitors, which include the well-known Viagra (another name for this is sildenafil). Other drugs in this class are vardenafil and tadalafil. Note that a prescription is required for these medications because they can have some deadly drug interactions.

Effectivenss with heart failure

Just how effective are these medications in people with heart failure? One study showed that sildenafil improves erection by 70% in people with heart disease.³ However, sildenafil may lower blood pressure, leading to dizziness and fainting in some.

While these drugs are effective, it is very important to avoid combining them with any form of nitroglycerin, which is commonly used for angina. The combination can be deadly.

Other treatments

There are other treatment options other than PDE-5 inhibitors. These include devices to help keep an erection, including some implanted and vacuum options. Hormone therapy with medicated testosterone may also be suitable, depending on the cause of ED.

It is important to never purchase medications over the counter that claim to help with ED. These products tend to be herbal and have quite a few drug interactions with other heart failure medications.

Opening up

Divulging your sexual concerns to a member of your healthcare team can be a scary experience for some men. Many healthcare professionals are now trained in providing an individual approach to discussing sexual relations with their patients. These conversations may not be easy, but it is the first step to getting treatment and help.