ED refers to a condition of blood flow that many Los Angeles men overlook. Men in Los Angeles not only put off going to get ED symptoms checked out, they typically notice symptoms of heart disease years before they start to experience symptoms of heart disease like chest pains, fatigue, or difficulty breathing after exertion. Men usually only notice these symptoms during private time, and treating them is often easy to attribute to age or relationship issues.

Dr. Tehrani usually sees patients who experience ED and have had cardiovascular problems for years.

ED Leads to Heart Failure

Erections require a flow of blood through the penis and the arteries must be free of plaque, and dilate properly, and be free of all of the inflammatory processes and stiff endothelial damage. All the same processes that cause the small arteries to dilate affect the large coronary arteries.

Penile arteries are smaller than coronary arteries. This size difference means that the beginnings of vascular disease are often first observed in the penile arteries as opposed to the coronary arteries. A man can be the first to report symptoms of vascular disease 3 to 5 years before the first symptoms of coronary artery disease are noted. Consequently, this time frame can be one of the most important windows in the prevention of cardiovascular disease, if not overlooked.

Erectile dysfunction (ED) in men under the age of 60 has become recognized as a precursor to cardiovascular disease. Erectil Dysfunction is more than a problem of sexual wellbeing. It is a sign that should be reported to a doctor.

Shared Risks

The primary factors that contribute to ED and heart disease overlap, and include:

– Hypertension

– Dislipidemia

– Type 2 diabetes

– Obesity, especially abdominal obesity

– Nicotine use

– Inactivity

– Sleep apnea

– Chronic stress

– Problem drinking

– Testosterone deficiency

In Los Angeles men, several of these factors are often present at the same time. The long work hours, unplanned lifestyles and thoughts, and the culture of dining and socializing in the city, contribute additional concurrent risks. Interestingly, busy professionals, especially men in their 40s and 50s, often dismiss ED, even when many of them are suffering from early, and unaddressed, cardiovascular disease.

Why Men Remain Quiet About It

ED is a topic that is even less popular with the general population that frequently visits the doctor. Some core beliefs are as follow:

– The topic is likely to be perceived as embarrassing and unrelated to ‘real’ medical issues.

– Patients think of ED as a just a part of the aging process.

– The internet, and telehealth, have given the population the opportunity to conveniently get prescriptions without the trouble of going through a proper medical assessment.

– Symptoms can be easily dismissed as they tend to be intermittent.

– Men are afraid that by bringing this up unnecessary testing will be conducted.

The end result is a large population of men in Los Angeles and America that are self-medicating the symptom of ED with the use of sildenafil or tadalafil without exploring the real issue which is the vascular system.

A Guide to Cardiac Evaluations

If you are less than 60 years old and have developed new or worsening ED, several findings should be included in your thoughtful evaluation:

– Cardiovascular health history — history of early cardiac events in the family, previous symptoms, review of lifestyle

– Blood pressure — assessed both in the office and home visits in case of inconsistency

– Lipid profile — cholesterol, LDL, HDL, and triglycerides

– Diabetes risk assessment — fasting glucose and HbA1c

– Hormone Testing — testosterone and other relevant thyroid hormones

– EKG — to assess for silent events and to establish a baseline rhythm

– Stress testing or imaging — as indicated based on risk factors and clinical judgement

– Review of lifestyle and medication — including those frequently used as part of the wellness practices in LA.

The idea is not to create more ED-related problems. The idea is to be aware that ED is often an early warning sign.

Medications, Telehealth, and Cautions

Generally, the four main PDE5 Inhibitors (sildenafil, tadalafil, vardenafil, and avanafil) are both effective and safe for the majority; however, the following are cardiac concerns regarding these medications:

– When used for chest pain, nitrates and PDE5 inhibitors should not be taken together due to the risk of extremely low blood pressure.

– Special considerations are necessary for the use of PDE5 Inhibitors with some blood pressure medications (especially alpha agonists).

– Medications should not be prescribed until cardiac care clearances have been obtained for men with recent cardiac events, unstable angina, severely decreased cardiac output and heart failure, and significant arrhythmias.

A lot of telehealth services bypass one of the most important steps of the ED prescription process: cardiovascular evaluation.

When telehealth services prescribe ED medicine and do not check your heart, they are missing an important part of the process.

What You Can Do Now

When ED stems from the development of early vascular disease, the steps to achieve optimal heart health and vascular health are the same:

– Move daily. Just a 30-minute brisk walk improves vascular and erectile health.

– Manage blood pressure and cholesterol. Both conditions are risk factors and they both have negative impacts on sexual health.

– Manage diabetes and prediabetes. This is key for blood sugar control.

– Treat your sleep. Sleep apnea worsens erectile dysfunction (ED), lowers testosterone levels, and increases the risk of cardiovascular disease.

– Quit smoking and vaping. Vascular health improves in a matter of weeks.

– Drink alcohol in moderation. Excessive alcohol worsens the vascular and sexual health areas.

– Manage your stress. Chronic stress constricts water and disrupts sleep.

– Strength train. Resistance training supports testosterone, weight management, and metabolic health.

Within a matter of months, many men see a significant improvement in sexual function and experience lower blood pressure, better cholesterol levels, and a reduced risk of heart disease.

When to See a Cardiac Specialist

You should see a cardiac surgeon or cardiologist if you have:

– New or worsening erectile dysfunction (ED) that is present in males under age 60

– ED with high blood pressure, diabetes, high cholesterol, and/or early onset heart disease in your family

– ED with any chest pains or discomfort, shortness of breath, or decreased tolerance to exercise

– Had a previous cardiac event with no clarity on the safety of using ED medications for you

– The intention to use ED treatment without an assessment of your cardiac health

Book an Appointment in Westwood

ED is not only an issue that bothers a man’s quality of life. It may also be the first observable sign of heart disease that has been developing for many years in a man’s body. If you already have some risks for heart disease, and you observe a change in your sexual ability, you are welcome to have a comprehensive assessment with cardiovascular specialist Dr. Maria Tehrani in Los Angeles for men. The conversations are intended to be private and respectful and to focus on the assessment of your heart health.

Dr. Tehrani serves Westwood, Brentwood, Beverly Hills, Santa Monica, Century City, Bel Air, Palisades Pacific, Marina del Rey, and Culver City.