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Erectile dysfunction is a widespread problem. Up to 50% of 40 yrs old and above men report some degree of erectile dysfunction and approximately 80% of men over 70 have significant symptoms.

Erectile dysfunction isn't life-threatening, but that doesn't mean it's not serious. Men with erectile dysfunction (ED) are more likely to feel depressed and report less enjoyment in life.

You may have heard more about erectile dysfunction than you ever cared to. But did you know that atherosclerosis is the main cause of ED? Having erectile dysfunction strongly suggests atherosclerosis may be elsewhere, like your heart.

The link between atherosclerosis and erectile dysfunction is well known to doctors. If you have ED, understanding the connection might just save your life.

Atherosclerosis and Erectile Dysfunction: A Vulnerable Rush

The blood supply to the penis comes from arteries in the abdomen (belly). Smaller arteries branch off to carry blood down into the penis. When it's time for an erection, these arteries dilate. More blood flows into the penis, causing it to swell.

The rush of blood creates high pressure in the penis that also slows down the flow of blood out of the penis. This produces a firm erection that can be maintained until orgasm, if the blood vessels are healthy.

Atherosclerosis and Erectile Dysfunction: Dam Blockages?

To get and maintain an erection, blood vessels in the penis have to be robust, to rapidly increase blood flow. Erectile dysfunction usually means blood vessels everywhere aren't in perfect viagra cialis online pharmacy pharmacy. This can be a signal of increased risk, long before blockages from atherosclerosis form.

To understand what goes wrong, think of blood flow as a river over a dam. Engineers control the flow: they can increase flow to make rapids, or narrow it to a trickling stream.

A similar mechanism is at work in your arteries. In your penis, blood flow needs to open wide during sexual arousal. Likewise, you need wide open blood flow to your heart's arteries during exercise. The inside lining of blood vessels (endothelium) releases chemicals on demand to accomplish this.

The endothelium can be damaged by high cholesterol, high blood pressure, smoking, or diabetes. They also cause atherosclerosis.

Once damaged, the endothelium can't expand arteries to increase blood flow as well. Less blood flow into the penis means a less firm erection.

Atherosclerosis and Erectile Dysfunction: The Early Warning Sign

The endothelium also acts like a maintenance crew that prevents atherosclerosis plaques from developing. Damage to the endothelium occurs before blockages from atherosclerosis appear.

Doctors have long recognized erectile dysfunction as an "early warning sign" for atherosclerosis. Difficulty with erections usually means atherosclerosis is developing. Erectile dysfunction can also mean atherosclerosis is already present, in the arteries of the heart or brain.

Most men with erectile dysfunction have risk factors for atherosclerosis, including:

• High cholesterol levels
• High blood pressure
• Diabetes
• Obesity

Diabetes seems to be particularly hard on the arteries in the penis. Most of the men with diabetes report some degree of impotence.

For these reasons, erectile dysfunction is a red flag that demands attention.

Of course, other factors besides atherosclerosis can cause erectile dysfunction. Problems with nerves, hormones, and emotional factors must be ruled out. Seeing a doctor can sort this out.

Atherosclerosis and Erectile Dysfunction: Solutions

The only way to slow down or prevent atherosclerosis is to reduce your risk factors. Don't smoke. Get your cholesterol and blood pressure under control. Exercise regularly. Eat right.

Erectile dysfunction can be the "canary in the coal mine" for serious complications of atherosclerosis. If you suffer from poor erections or impotence, take it seriously. See your doctor, and ask if more than your sex life may be at risk.

So the result is, sex problems (E.D.) are not related with your sex life only, these are related with your LIFE……….. So, kindly don’t ignore it.

December 4, 2008 — The Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial, a large morbidity and mortality study comparing the effects of two forms of antihypertensive combination therapies on major fatal and nonfatal cardiovascular events, is now published in the December 4, 2008 issue of the New England Journal of Medicine [1].

The trial was stopped early because treatment with antihypertensive combination therapy — the angiotensin-converting enzyme (ACE) inhibitor benazepril plus the calcium-channel blocker amlodipine — was more effective than treatment with the ACE inhibitor and diuretic. First presented at the American College of Cardiology 2008 Scientific Sessions in Chicago, IL and reported by heartwire at that time, the results showed that the single-tablet benazepril/amlodipine combination reduced the risk of morbidity and mortality by 20% compared with conventional therapy.

"We have guidelines stating a preference for diuretics as monotherapy or to use diuretics and an ACE inhibitor in combination therapy," lead investigator Dr Kenneth Jamerson (University of Michigan, Ann Arbor) told heartwire. "We now have data that suggest that combination therapy is probably a good initial strategy for high-risk patients, rather than starting with one drug and going slow. Putting patients on either combination doubled their control rate, so combination therapy is something clinicians need to think about, even if they want to keep the diuretic. But the drug that gives superior cardiovascular outcomes is the calcium-channel blocker and ACE inhibitor."

Commenting on the results, Dr Franz Messerli (St Luke's-Roosevelt Hospital, New York), who was not part of the study, said ACCOMPLISH should change the way clinicians treat patients with hypertension.

"This landmark study unequivocally relegates hydrochlorothiazide from first-line to third-line therapy at least in a patient population with similar demographic and clinical features as in ACCOMPLISH," said Messerli. "The issue is not to be taken lightly, since hydrochlorothiazide remains one of the most commonly prescribed antihypertensive drugs. Every year more than 100 million prescriptions of hydrochlorothiazide are written in the US. Almost half of those prescriptions are written for hydrochlorothiazide alone, and the remainder for fixed combinations, mostly with either ACE inhibitors or angiotensin receptor blockers."

High-risk patient population

ACCOMPLISH compared the effects of the two forms of antihypertensive combination therapies on major fatal and nonfatal cardiovascular events in 11,506 men and women aged 55 years or older who had systolic blood pressure ≥ 160 mm Hg. All patients were currently on antihypertensive therapy and had evidence of cardiovascular or renal disease or target-organ damage. Patients enrolled in the trial were obese, with 60% having diabetes mellitus, and nearly all had been treated previously for hypertension.

Despite being treated previously — more than 70% of patients in the trial were currently taking two or more hypertensive agents — just 37.3% of patients had their blood pressure controlled to <>Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7). As part of the study protocol, all patients stopped their medication and, without a washout period, were randomized to combination treatment with benazepril plus hydrochlorothiazide or amlodipine plus benazepril.

The study was terminated after a mean follow-up of 36 months. Jamerson noted that patients in both treatment arms received excellent blood-pressure control, with blood pressures of 132/73 mm Hg in the benazepril/amlodipine arm and 133/74 mm Hg in the benazepril/hydrochlorothiazide arm.

Regarding the primary end point, a composite of death from cardiovascular causes, nonfatal myocardial infarction (MI), nonfatal stroke, hospitalization for angina, resuscitation after sudden cardiac arrest, and coronary revascularization, 9.6% of patients in the benazepril/amlodipine arm had an event compared with 11.8% in the benazepril/hydrochlorothiazide arm. This absolute 2.2% benefit translated into a 20% relative reduction in risk.

ACCOMPLISH: Primary and secondary end points

In an editorial accompanying the published study [2], Dr Aram Chobanian (Boston University School of Medicine, MA), who served as chair for the JNC-7 hypertension guidelines, agrees that a recommendation of thiazide-type diuretics as initial therapy for most patients with hypertension needs to be reexamined.

"The results from the many recent studies, including the ACCOMPLISH trial, when considered together, suggest that greater flexibility is now indicated in the choice of the initial drug," writes Chobanian. The drug of choice depends on criteria such as compelling indications or contraindications, as well as coexisting conditions, adverse effects, race, and the clinician's experience, he said.

This increased flexibility, however, "should not negate the importance of diuretics," a cornerstone of antihypertensive therapy for 50 years, stressed Chobanian. In addition, the findings "should not diminish the value of treatment with the combination an ACE inhibitor and a diuretic," an effective combination for lowering blood pressure, as observed in ACCOMPLISH, "that was recently shown to produce major reductions in mortality and morbidity in the very old," noted Chobanian.

In his editorial, Chobanian, like others before him, pointed out that the diuretic used in ACCOMPLISH differed from the diuretic used in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Chlorthalidone, the ALLHAT diuretic, is estimated to be twice as potent as hydrochlorothiazide and to have a longer duration of effect in the 12.5- to 25-mg dose range.

Countering these criticisms, Jamerson said that 90% of clinicians in the US use hydrochlorothiazide, and most of these are using it at doses ranging from 12.5 mg to 25 mg, the dose used in ACCOMPLISH.

"Our message is really simple," said Jamerson. "For the thiazide that most people are using, even if they were able to get the blood pressure down to 130 mm Hg, which most clinicians in the US are not doing, the ACE inhibitor/calcium-channel-blocker combination would still give you better cardiovascular outcomes. For a lot of people, if you're using a combination, this ought to be a strategy to consider."

With doctors using hydrochlorothiazide for hypertension for half a century, Messerli told heartwire that ACCOMPLISH indicates that it is time to turn the page.