A few months ago a we received a request for help setting up in-office services to provide vascular testing for a urology patients. This busy urology practice had the equipment and the room, but they weren’t sure they had the patients. For many years, NAVIX has provided vascular testing for urology patients, mostly for penile blood pressures to see if a patient’s erectile dysfunction (ED) may be related to blood flow. But in the past several years there have been numerous studies that have flagged ED as an early indicator of peripheral arterial disease (PAD) and coronary artery disease(CAD), so we discussed how their patient population were at higher risk for heart attack, stroke, and limb loss, and that we were sure that they have the Vascular patients.
So we discussed how setting up a Vascular Lab in the Urology practice could be beneficial. Some of the statistics related to ED and PAD were impressive and eye-opening:
- Approximately 150 million people are affected worldwide and the number is expected to more than double by the year 2025;
- Age-related decline in erectile function was always viewed as a psychological disorder and it wasn’t until the late 20th century that ED was recognized as a physical abnormality affecting penile blood flow as part of a bigger vascular disorder;
- Between 40 and 70 years of age the prevalence of ED is approximately 52%;
- In men with CAD, the prevalence of ED is as high as 75%.
Atherosclerosis , the primary cause of CAD and PAD, is a systemic problem – when you’re diagnosed with it in one artery you probably have some atherosclerotic plaque in most of them. There are many risk factors for atherosclerosis including smoking, high blood pressure, diabetes, and obesity, which just so happen to be the big risk factors for ED too. The arteries supplying the penis are relatively the same size as the arteries feeding the heart, so problems with ED could be an early sign of an impending heart attack (CAD) or that you will develop problems with the blood flow to your legs (PAD). So to put it very succinctly, ED may be the ”first manifestation of a single clinical disease spectrum that will progress to include coronary artery disease (CAD) and peripheral artery disease (PAD) at a later stage”.
The CEO of the practice asked us if we knew what ED was. We looked at each other and assured him that we had seen the commercials for Viagra and Cialis. He said the definition of ED is “the recurrent or persistent inability to achieve or maintain an erection in order for satisfactory intercourse to occur”. He said that there are many treatments for ED but the reason that those drugs work is that they act upon the inflow of blood, so if there is a problem with the blood flow, even those drugs might not work.
It was obvious to all of us that that the Urology practice had patients at high risk for PAD and that Vascular Testing would indeed be of benefit to this patient population. We discussed logistics and equipment and staffing and we said that we would reconvene after the Holidays.
But all of this got me thinking – what if we could see these patients sooner. One thing that stuck out for me was the point they made that while Urology treats patients with ED, ED patients only see the Urologist when it becomes a really big problem and then again only in those with sex life (sorry to be so blunt). There are many men out there with ED who are wary of going to see a physician for their issues because they’re either embarrassed or they think that it “happens to everyone”. So what if we could identify these patients sooner? We need to start educating all healthcare practitioners and patients on the importance of discussing ED.
It seems to me that all health practitioners should be asking about ED. While it may be embarrassing to ask someone who is coming to see you for a routine check-up or for their flu symptoms about their ability to get an erection, it’s seems important to look for early warning signs of CAD and PAD, don’t you think? And don’t just give them a questionnaire to fill out, tell them about the risks and get them tested.
In the same vein, men who would like to prevent a heart attack, or a stroke, or an amputation should discuss these ED issues with their doctor or practitioner. These people are professionals after all and you shouldn’t be embarrassed to bring it up. And if your partner is having a problem and you go with them for their medical appointment, tell the nurse or doctor about it – you may save your partners life or limb.
Additional reading:
- Erectile Dysfunction Linked to Heart Disease. Published on-line 30-January 2013. http://www.medicalnewstoday.com/articles/255638.php
- Meller SM, Stilp E, Walker CN, et al. The Link Between Vasculogenic Erectile Dysfunction, Coronary Artery Disease, and Peripheral Artery Disease . J Invasive Cardiolo 2013;25(6):313-319. http://www.medscape.com/viewarticle/806321