If erectile dysfunction appears, check cardiovascular health first — don’t treat it as a purely sexual issue

Men with erectile dysfunction later develop cardiovascular disease at roughly 40% higher rates than other men, and heart attacks at about 60% higher rates. The younger a man is, the greater this difference becomes. This problem often shows up before any chest pain does. Therefore, it’s wise to check blood pressure, blood sugar, and cholesterol levels rather than simply self‑medicating.

A doctor’s visit costs just a few dozen yuan. Measuring blood pressure and running tests for blood sugar and cholesterol adds another hundred or so yuan. One trip to the hospital yields results after a few days.

One meta‑analysis combined data from 14 long‑term studies involving 92,757 men, followed for an average of 6.1 years. Compared with men without erectile dysfunction, those with the condition faced higher risks as follows: overall cardiovascular events rose by roughly 44% (RR 1.44, 95% CI 1.27–1.63). Heart attacks increased by about 62% (RR 1.62, 95% CI 1.34–1.96). Cerebrovascular events rose by roughly 39% (RR 1.39, 95% CI 1.23–1.57). All‑cause mortality went up by about 25% (RR 1.25, 95% CI 1.12–1.39). No significant difference appeared for cardiovascular‑related deaths (RR 1.19, 95% CI 0.97–1.46). The risk elevation was greater in younger men and in those whose baseline cardiovascular risk was moderate. Studies that used questionnaire‑based diagnosis reported an RR of 1.61 (95% CI 1.38–1.86), while studies asking just one question gave an RR of 1.27 (95% CI 1.18–1.37).

These 14 studies tracked groups of men over time; they are not randomized controlled trials. Hence the “40% higher” figure reflects an association, not a proven cause‑and‑effect relationship. Occasional episodes do not count; the condition is considered present only when symptoms persist for three months or more. The tests recommended — blood pressure measurement, fasting blood‑glucose testing, plus cholesterol checks, smoking status assessment, and waist‑circumference measurement — are the same as those listed in sections 7 and 8 of this chapter. Avoid purchasing “male‑enhancement” supplements online; legitimate medications for this purpose are prescription drugs, and their instructions list nitrates as a contraindication — meaning men already taking nitroglycerin or similar drugs must not use them, as doing so can cause a sudden drop in blood pressure. For ways to improve erectile function, see section 29 (weight loss and smoking cessation can help). The benefit is rated “moderate” rather than “large”: the 44% figure represents the difference between two groups, not the actual reduction in mortality achieved by testing. It is also not “small”; unlike the situation described in section 27 (visible blood in urine), where detection alone is the benefit, here hypertension, diabetes, and abnormal cholesterol levels each have established treatments available.

Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI (2013). Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circulation: Cardiovascular Quality and Outcomes, 6(1), 99-109. https://doi.org/10.1161/CIRCOUTCOMES.112.966903；DailyMed（美国国立医学图书馆的药品说明书库）. VIAGRA (sildenafil citrate) tablet, CONTRAINDICATIONS. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d905dc8d-917f-4ea3-a4ee-a1ecf6967d4e；NHS. Erectile dysfunction (impotence)：「Most men occasionally fail to get or keep an erection. This is usually caused by stress, tiredness or drinking too much alcohol, and it's nothing to worry about.」「See a GP or go to a sexual health clinic if: erection problems keep happening」. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/