Impotence often precedes a heart attack by three to five years (Curr Vasc Pharmacol, 2021;19(3):301-312). A review of the scientific literature found that men who are impotent have a 59 percent increased risk for heart attacks, a 34 percent increased risk for a stroke, and a 33 percent increased risk for dying from any cause (J of Sexual Medicine, July 01, 2019;16(7):1005-1017). One study showed that impotent men were twice as likely to develop heart disease and had an 80 percent higher risk of already suffering from heart disease (Mayo Clinic Proceedings, February 2009).

Beware of a doctor who treats impotence with testosterone without recommending an evaluation for heart attack risk factors. Testosterone will not prevent a heart attack, and men who are impotent and have low testosterone levels still are at significantly increased risk for heart attacks (J of Clin Endo & Metab, Nov 2013;98(11)).

A recent study found that phosphodiesterase 5 inhibitors (PDE5i) used to treat impotence, such as Viagra, are associated with reduced risk for heart attacks, heart failure, and the need for angioplasty or bypass surgery in men who are impotent (J Am Coll Cardiol, March 2021;77(12):1535–1550). Higher doses offered greater protection from a heart attack. However, this study showed only an association between these benefits; it did not show that the drugs used to treat impotence prevent heart attacks.

Risk Factors for Impotence and Heart Attacks
Impotence and heart attacks share many common risk factors:
• Type II diabetes
• smoking
• excess alcohol intake
• high blood pressure
• obesity
• high levels of the bad LDL cholesterol and triglycerides, and lower levels of the good HDL cholesterol (Int J of Impotence Res, December 19, 2013)
• plaques blocking arteries leading to the heart (Int Urol Nephrol, 2008;40(1):117-23)
• higher calcium scores than age-matched men who were not impotent (J Urology, April 2010;183(4s):e1-e892). Calcium scores indicate the size of plaques measured in arteries, so the test is used as a predictor of future heart attack.
• abnormal coronary angiograms, a test for blocked arteries leading to the heart and for coronary artery ectasia, a ballooning of arteries that signifies arterial damage (International Journal of Impotence Research, May/June 2011;23:128-133)
• low testosterone levels that increase risk for impotence also are associated with increased risk for a heart attack.

Impotence and Inflammation
Impotence is felt often to be caused by an overactive immunity, called inflammation, that damages the smooth muscles and inner linings of arteries leading to the penis. Heart attacks are believed to be caused by damage to the same factors. First, inflammation punches holes in the inner lining of arteries that causes bleeding, then clotting and then plaques start to form that decrease blood flow to the penis that can inhibit an erection.

My Recommendations
Failure to achieve erections does not always indicate that you have an underlying heart problem. However, all men who consistently have difficulty achieving erections should be screened for heart disease. If you are impotent, check with your doctor for a medical evaluation and get instructions on starting a lifestyle program to help prevent heart attacks that may also help to treat your impotence:
• lose excess weight
• exercise regularly
• do resistance exercises to grow larger muscles
• follow an anti-inflammatory diet: eat lots of vegetables, fruits, beans, and nuts, and severely restrict red meat, sugared drinks, sugar-added foods and fried foods (Nutrients, Jan 2021;13(1):108)
• limit or avoid alcoholic beverages
• avoid smoking and second-hand smoke
• keep blood levels of hydroxy vitamin D above 30 ng/mL