Is your patient’s sexual dysfunction an early indicator of serious cardiovascular disease? In this episode of BackTable Urology, Dr. Amy Pearlman teams up with preventative cardiologist Dr. Dapo Iluyomade to discuss the relationship between erectile dysfunction (ED) and cardiovascular disease, and the holistic approach needed to prevent both of these chronic conditions from worsening.
SYNPOSIS
Dr. Iluyomade shares his preventive cardiology workup, the significance of lipid panels, and advanced diagnostics. They also explore the effects of common cardiovascular medications like beta blockers on sexual health and address common concerns related to testosterone and hormone therapies in both men and women. The conversation underscores the importance of interdisciplinary collaboration between urology and cardiology for optimal outcomes in patients with sexual dysfunction.
TIMESTAMPS
00:00 - Introduction
01:52 - The Intersection of Cardiology and Urology
03:43 - Understanding Preventive Cardiology
07:56 - Patient Risk Stratification and Workup
16:35 - Cardiovascular Health in Women
20:07 - Testosterone Therapy and Cardiovascular Risk
26:39 - Hormone Replacement Therapy in Men and Women
36:09 - Beta Blockers and Sexual Dysfunction
42:36 - Diuretics and Sexual Health
48:57 - A Message to Urologists from a Cardiologist
Erectile Dysfunction: The Overlooked Warning Sign for Heart Disease—A Urologist and Cardiologist's Collaborative Approach
Erectile dysfunction (ED) is often regarded solely as a urological issue, but mounting evidence highlights its critical role as an early marker for cardiovascular disease (CVD)—particularly in men under 55. In a recent episode of the Backtable Urology Podcast, Dr. Amy Pearlman, urologist, and Dr. Dapo Illuya, preventive cardiologist at Miami Cardiac and Vascular Institute, unpacked the intersection of sexual and cardiovascular health, and shared actionable strategies for clinicians aiming to optimize patient outcomes.
The Penis as a Barometer for Heart Health
Dr. Illuya underscores that “patients present typically two to three years before their cardiovascular symptoms—they present with erectile symptoms.” Penile arteries are significantly smaller than coronary arteries, making them more vulnerable to early vascular injury. A memorable analogy compares the tip of a pen (roughly the diameter of the cavernosal artery) to the back of the pen (the size of a coronary artery)—meaning vascular disease often shows up in erections before more “classic” cardiac events.
Screening: Opportunities and Key Recommendations
According to population studies, approximately 20% of men over age 40 have at least mild ED, but fewer than 20% discuss it with their doctor. Dr. Illuya recommends clinicians—especially in cardiology and urology—to routinely ask normalizing questions about sexual function, energy, and mood, as these conversations often reveal hidden cardiovascular risk.
When younger men (<55) present with ED, Dr. Illuya advocates for:
- Calcium score scan: A rapid CT assessing arterial plaque burden, which can uncover otherwise hidden atherosclerotic disease.
- Preventive cardiology consult: To evaluate broader cardiovascular risk and initiate early prevention strategies.
- Comprehensive metabolic panel
- Advanced lipid panel (including apolipoprotein B, Lipoprotein(a))
- High-sensitivity C-reactive protein (hs-CRP), a marker of inflammation
The foundation of preventive cardiology involves lifestyle intervention—emphasizing a Mediterranean diet, regular aerobic and resistance exercise, stress reduction, and sufficient sleep. Lipid management is increasingly sophisticated:
- Lipoprotein(a): A genetically determined risk factor, elevated in one out of every five people worldwide, and persistently associated with higher odds of heart attack and stroke.
- hs-CRP: Even when traditional risk factors are controlled, chronic inflammation continues to drive adverse cardiac events. Lower hs-CRP (<2) is a key goal.
Testosterone Replacement and Cardiovascular Safety
Testosterone therapy—long maligned for supposed cardiovascular risks—has been reevaluated thanks to large recent trials like TRAVERSE, which demonstrated no increased risk of major cardiac events with guideline-driven therapy. “If testosterone cypionate caused a statistically significant increase in major cardiac events, we probably would have seen it by now,” Dr. Pearlman affirms, though both experts counsel caution in specific cases like men with genetic clotting disorders or significant heart failure.
Cardiovascular Medications: Effects on Sexual Function
Beta blockers have a reputation for impairing erections, but the class is not monolithic. Older agents such as atenolol and metoprolol are more likely to cause ED, whereas newer agents like nebivolol—a nitric oxide-mediated vasodilator—may actually improve erectile function. Carvedilol is another alternative with a lower incidence of ED. For thiazide diuretics (like hydrochlorothiazide), which also cause notable sexual side effects, alternatives such as eplerenone are preferred.
ACE inhibitors, ARBs, statins, and modern diabetes medications (e.g., SGLT2 inhibitors, GLP-1 agonists) are generally neutral or even beneficial from a sexual function standpoint.
Integrating Sexual Health into Cardiovascular Care
Despite the clear physiologic links, sexual health is rarely discussed in many cardiology practices. Dr. Illuya credits his patient-centered approach—asking about sexual function and mood—as essential for building trust and treating patients holistically. He calls for all cardiologists to routinely initiate these conversations, emphasizing that addressing the true concerns impacting quality of life can deeply influence motivation for cardiovascular risk reduction.
A Collaborative Call to Action
Dr. Illuya’s megaphone message for urologists: “Erectile dysfunction should be considered subclinical atherosclerosis until proven otherwise.” In men under 55, ED signals the need for cardiovascular evaluation; appropriate labs and possible calcium scoring can be life-saving. Shared care and open communication between urologists and cardiologists are crucial to improving both longevity and quality of life.
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