nutrition

ED as a Precursor to Cardiac Disease

Erectile dysfunction is not a trivial symptom and not necessarily normal as men get older. This information for me is new and eye-opening.

After my recent heart issues, surgery and eventual recovery I have spent hours reading various medical articles in addition to my usual Wall Street Journal and New York Times early morning perusal of the newsy items presented there. During one of these excursions I tripped over (my phrase for it) an article about erectile dysfunction which is a topic of discussion every man gets during an annual physical with his primary care person.

In my case it is often phrased – Do you experience erectile dysfunction? And my answer often is – I am a 76 year old man, what do you think? I have often, maybe always, made a joke about it and the young female medical assistant who is filing in the standard questions required by the medical hierarchy laughs along with me.

A few days ago I discovered this gem from the Mayo Clinic. https://www.mayoclinic.org/medical-professionals/urology/news/erectile-dysfunction-a-vital-sign-for-cardiovascular-health/mac-20585074

The 2023 Princeton IV (P4) consensus guidelines bring a game-changing message to clinicians: Erectile dysfunction (ED) is not just a quality-of-life issue but also a red flag for cardiovascular disease (CVD). This multidisciplinary expert panel urges healthcare professionals to view ED as a risk-enhancing marker for silent coronary artery disease (CAD), especially in younger men who appear otherwise healthy. The consensus guidelines were published in a 2024 issue of The Journal of Sexual Medicine.

More: Why ED deserves serious attention

ED often occurs 2 to 5 years before men experience heart attacks. Because the penile arteries are only 1 to 2 mm wide, they’re among the first vessels to show signs of atherosclerosis. In many cases, ED is the earliest — and only — visible symptom of cardiovascular disease.

Wow. Had I an inkling of this connection I would have asked for a cardiac stress test. Or maybe this test referred to next.

The P4 panel recommendations confirm that ED is a strong, independent predictor of cardiac events, even when traditional risk factors such as cholesterol, diabetes and blood pressure are controlled for. In short, ED is the body’s “check engine light” for heart disease.

New guidelines: Reassess risk with better tools

Dr. Kohler and the P4 team advocate using coronary artery calcium (CAC) scoring in patients with ED and borderline (5% to 7.5%) or intermediate (7.5% to 20%) 10-year atherosclerotic CVD risk. This quick, noninvasive CT scan is one of the most sensitive and specific ways to detect subclinical CAD, especially in patients ages 40 to 60, whose risk is often underestimated.

Finding a high CAC score (above 100) can lead to early intervention: statins, aspirin, lifestyle counseling and, in some cases, cardiology referral. This single test can turn a routine men’s health visit into a lifesaving diagnosis.

Too late for me. I found my blockage while riding on my favorite bike trail. I could have found it before that day. I’m complaining about not figuring it out sooner. And perhaps my own complacency is complicit here. PCPs only see their patients once or twice a year and it is up to the patient to discuss the things that are not working correctly. (Men generally are shy about discussing their reproductive equipment. I am no exception.)

Both of my parents had heart problems. Mom had bypass graft surgery in her mid-seventies and lived to be 95.

I miss her whenever I throw away a cardboard box.

Carpe Diem.

Coffee

This morning on the CBS news they reported on a piece about an association with drinking coffee and a resistance to dementia. Good News! Us coffee drinkers will not be demented – later in life? Ever? Only in our nineties? Oh wait. She said association. That term has a very specific meaning to statistical studies.

This study was based on the female participants in the Nurses’ Health Study (NHS; n = 86 606 with data from 1980-2023) and male participants from the Health Professionals Follow-up Study (HPFS; n = 45 215 with data from 1986-2023) who did not have cancer, Parkinson disease, or dementia at study entry (baseline) in the US.

You have got to love those numbers. Health care workers have been drinking coffee for forty-three years. And recording it.

Journal of the American Medical Association (JAMA): https://jamanetwork.com/journals/jama/fullarticle/2844764

From JAMA — Conclusions and Relevance: Greater consumption of caffeinated coffee and tea was associated with lower risk of dementia and modestly better cognitive function, with the most pronounced association at moderate intake levels. (I want to say, “Hell yeah!” here.)

Association — Association refers to the general relationship and is normally used for studying relationship between two nominal/categorical/ordinal attributes;

Correlation — whereas correlation refers to a linear relationship between two quantitative attributes. It would not be out of context to mention here that the relationship between two quantitative variables can even be a nonlinear as well such as curvilinear or exponential.

[from https://journals.lww.com/cmre/fulltext/2021/11010/understanding_statistical_association_and.7.aspx%5D

Causation — Causation means that a change in one variable causes a change in another variable.

So, to conclude, not drinking coffee does not cause dementia. It might cause those sleepy “whaat?” looks that teens display in early morning classes but the WL study is incomplete at this time.

I am interested in statistical analysis. The math is attractive to me. I am deficient at recognizing patterns but I do recognize my wakefulness after coffee in the morning.