Ep. 82: Erectile Dysfunction & Heart Disease: The Connection You Can't Ignore

Erectile Dysfunction is the sign of bigger problems than a man's inability to get and/ or stay hard. Over half the men with heart disease suffer from ED.

ED is an independent risk factor for cardiovascular disease because men with ED develop it within 2 to 5 years. And then there's Testosterone. Is it good for your heart? What can COVID do to erectile function, and what's the Testosterone link? What about Viagra and Cialis?

Tune in to hear my discussion with board certified interventional cardiologis Dr. Jyoti Mohanty.

Dr. Kanwal Bawa is America's favorite sex doctor, and the host of America's number one sex podcast, Dr. Sex Fairy. She is Cleveland Clinic trained, and a pioneer in the fields of sexual wellness, skin rejuvenation and hair restoration. She has a state-of-the-art practice in Boca Raton, Florida called Bawa Medical. She earned the moniker Dr. Sex Fairy due to her incredible advances in the field of intimate and sexual wellness.
 
Her patients fly to her from all over the world for vaginal rejuvenation, non-surgical labiaplasty, penis enlargement, Erectile Dysfunction treatments, better performance, increased libido, hormone replacement, and more. She also provides virtual consultations for those who are unable to travel to her for in-office treatments. Dr. Bawa also has her own line of Dr. Sex Fairy supplements which includes a testosterone booster, a nitric oxide booster and a libido enhancer.

To schedule a virtual or in-office consultation: https://www.bawamedical.com/contact/

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https://www.bawamedical.com/sexual-health/

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Transcript

0:12

Welcome to the Dr. Sex very podcast. I am Dr. Kaul Bava, America's favorite sex doctor, and I am here to transform your life. We often talk about erectile dysfunction or ed, which is the inability to get or maintain an erection sufficient for sexual intercourse. Today we are going to discuss a topic you have likely never thought. Did you know that there is a major connection between erectile dysfunction and heart disease? In fact, men who suffer from erectile dysfunction are twice as likely to suffer from heart disease according to the American College of Cardiology. Erectile dysfunction and cardiovascular disease share certain risk factors. These include age, sedentary lifestyle, obesity. Smoking, high cholesterol, metabolic syndrome, high blood pressure, diabetes, and more. Studies have found that erectile dysfunction is an independent risk factor for cardiovascular disease. Men with ED are far more likely to develop coronary artery disease, peripheral arterial disease, and even stroke. It is very important that men take the symptoms of erectile dysfunction serious. Because it often precedes heart disease by two to five years. I am joined on the Dr. Sex Ferry podcast today by Dr. Joti Mohank, board certified interventional cardiologist who trained at Chicago's famous Cook County Hospital, as well as Rush Presbyterian St. Luke's. He is Weiss chief of Cardiology at Jupi Medical Center. He has been in clinical practice in South Florida for over 20. And his practice advanced cardiovascular consultants has three offices located in North Palm Beach County. Needless to say, he has been around the block a few times. I am going to talk to Dr. Mahany about the connection between ED and heart disease, the risk factors for both, and before we end our convers. I will also talk to him about the little blue pill Viagra. So stick around till the end. Welcome Dr. Mohani. thank you for having me, Dr. Baba on this um, podcast. It's a pleasure to, uh, talk to you and, uh, come up current on the topics. Thank you so much for coming. Our listeners definitely need this discuss. Yes, certainly it is a very hot topic and a lot of my patients, they do ask these questions. We get a lot of cardiac clearance for, uh, patients, for ed, and, uh, other, uh, medications. Great. Let's launch right in. Let's start with the topic at hand, the connection between ED and heart disease. According to research, well over half the men diagnosed with heart disease have. How often do you see it in your patient population? We see a lot of patients with Ed and actually Ed has been, uh, seen in even younger patients. So we have patients in the age group of, uh, early thirties. Uh, they can go into their forties and definitely in the fifties, sixties and seventies. As you mentioned, ed seems to start surprisingly early in life. 30% of men in their thirties, 40% in their forties, and so on, about 10% for every decade of life. Now let's talk about age and the risk of heart disease. After the age of 45, in men, they tend to have increased risk of, uh, cardiovascular incident. Whether it is, uh, high cholesterol, whether they have high blood pressure, whether they will have heart attack or a stroke. These continue to, uh, increase with and other risk factors will, um, participate and will make it even, uh, worse, I often tell my patients about the dangers of smoking when it comes to erectile function. Smoking also affects the risk of heart disease. Please tell our listeners about that. Smoking is actually by far the most, uh, aggressive and the most important of all the risk factors in which I have seen in my practice only. To be followed with diabetes or as close with the diabetes. Patients who are smokers tends to have everything from involvement of their entire vascular system, and they will have increased risk of heart attack, increased risk of stroke. They have peripheral arterial disease, they have chronic limb ischemia means lack of blood flow to the um, leg and have the highest risk of amputation. And if these patients also have diabetes or high blood pressure with. They definitely will have a shorter lifespan compared to somebody who does not have this risk factors. So smoking, I would say probably stands on the highest of all the parameters and cardiovascular disease. See, this is what I always tell them. I stand validated based on what you're telling us. Now let's talk about other risk factors for heart. The other risk factors for heart disease include, as I said, after smoking comes, uh, diabetes and, uh, high blood pressure, high cholesterol, age being a male, low testosterone is also part of this, uh, syndrome and uh, also family history. These will make generally the most common, um, risk factors for coronary artery disease or atherosclerosis in men or women, both. Testosterone seems to be quite the important player here. It's also low in men who suffer from ED quite often. And of course, low testosterone is also an independent risk factor for heart disease. Absolutely. Very good point. So people think about as testosterone is a male, uh, boosting hormone, but with that it comes with a lot of advantages, especially when young people tend to have a low testosterone. They are increased risk of both heart disease, ischemic stroke. Development of diabetes, high cholesterol. Testosterone really plays a very, very important role in maintaining, uh, good homeostasis in the male. With low testosterone, you are going to develop something called metabolic syndrome, which will then in turn lead to more obesity development of diabetes. You are also going to get into sleep apnea, high cholesterol, and increase risk of stroke and heart. When it comes to testosterone, maintenance of the testosterone level is extremely, extremely important. yes, and I find that low testosterone levels are often the cause for Ed and some of the younger men. That is correct. So the testosterone, uh, when it comes to ed, the most common age group you will find is the young patients starting at the age of 35 to 40, and then going further beyond the correction or bringing the testosterone level to normal have been found more beneficial in younger patients compared to older patients. Studies done in Mayo Clinic and in Cleveland Clinic have shown. If testosterone therapy is given to older patients, they have very minimal cardiovascular benefits, but to younger patients, the benefit is immense, provided they are not using it for body building or as an anabolic steroid. So basically what you're telling us is that testosterone can actually be very preventative if taken at a young age for the risk of heart. Absolutely. Patients who will have low testosterone at the age of 30 or 35, 40, 45. They need to therapy for their normal body functioning, whether to keep the muscle mass, keep the cholesterol, and at a microvascular level. It works on endothelial, uh, functions and as well as the nerve function. And that's what basically leads to erectile dysfunction. Erectile dysfunction is a combination of neurological as well as vascular complications. Low testosterone plays a major role in these patients because of endothelial dysfunction, which is the lining of the blood vessels and can lead to spasm and low blood flow, which then leads to erectile dysfunction. Low testosterone has also been found to be very important in the nerve conduction business, and any kind of neuropathy, et cetera could lead to erectile dys. You know, it's interesting you brought up endothelial dysfunction because when covid happened, I saw a spike in patients coming in for erectile dysfunction, and coincidentally, I noticed that their ages were getting lower and lower, and it was found to be a case of endothelial dysfunction. Again, that was being caused by C O V D. And again, there was that testosterone link where men with lower testosterone were more likely to die of covid. and also Covid was causing men who were coming in with normal testosterone to have levels that were plummeting. So that's another interesting point, isn't it, with covid and testosterone and heart disease. Yes. That is a very, um, good observation. I think you made and bringing that point up because a lot of my patients have lot of questions regarding this. So in my clinical practice, I have definitely found that after Covid, there was a lot of increase in heart attack as well as blood clots in the lungs, blood clots in the legs, which is predominantly an endothelial dysfunction problem. Patients who tend to have low testosterone, they already have a problem with their endothelial dysfunction as well. They can have spasm and low blood flow, low nitric ox. And that will then lead to increase in clotting as well as increase in heart attack, increase in blood clots in the lungs caused as pulmonary embolism and erectile dysfunction. It is scientifically proven that this is what is the real reason why these patients are coming with the. Yes. And you know, initially when it started happening I asked myself, am I imagining this? And then I thought, no, I'm not imagining this. They are getting younger and more and more are complaining of it and were CD and the ones who already had it. So it was definitely cause and effect. There was no denying it. And when the studies came, I said, hallelujah, there it is. So at least then I had some numbers to tell my patients. Now certain blood pressure medications can also cause. and I see this most often with beta blockers, particularly metoprolol. What are your thoughts about this? metoprolol has been a drug, uh, of choice for high blood pressure, for heart failure, um, even tremors, et cetera, for quite some time when the late sixties and all, but being a beta blocker is blocking the adrenaline. Plays a major role in bringing down both the libido as well as the, the performance. And, uh, erectile dysfunction is very common in, uh, patients with beta blockers, especially in younger patients. And if the younger patients tend to have a low testosterone, The starting them on a beta blocker could be devastating for their erectile dysfunction and can, um, lead to lot more of, uh, depression as well as, um, other psychosomatic uh, problems. when I do my histories with my patients and I do a pretty thorough history, sometimes they get irritated. They say, why do I have to answer all these questions? And I say, because it. I really need to get to the basis, to the very reason why you have Ed. And sometimes we can find simple fixes. Not always, but sometimes we get lucky. And when I mention metoprolol, they say, okay, I'm stopping that today. And I say, no, no, no, you're going to talk to your cardiologist. And many times they say to me, well, I don't see a cardiologist. And when I asked them, have you ever seen one? They say, no. I go to my family doctor and I have to tell them, seriously, I have to tell. Your family doctor is great, but a cardiologist is a specialist In this. You have got to see a cardiologist. I agree with that completely. Especially patients who have, uh, low testosterone and patients who are on beta blockers. They may be taking the beta blocker for, um, heart arrhythmia. They may be taking for high blood pressure and maybe even a post heart attack and abruptly stopping the beta blockers can definitely cause, uh, some serious problem. It should be done just not by themself, but in with instruction with your. Primary care physician or taking the advantage of a cardiology consultation. But again, the low testosterone plays a major role in these patients. And because their sex life and ED seems to be the priority, uh, they tend to, uh, miss about the medication. And they would rather not take that medication and take a chance, um, and to have a better, um, sex life as well as, uh, better performance in the bedroom. Words of wisdom right there. Now, before we get into Viagra and Cialis and that whole story, let's talk about the current recommendations for cardiac screening. That is, again, a very good question, and, uh, cardiac screening should begin at a very early age. Initially when I was in my training, they used to do screening at the age of 50 55. That has now dropped. As per the American College of Cardiology guidelines, we do cardiac screening for patients at the age of 39 and above. These. Numbers will continue to come down as we are finding more and more patients, especially co post covid has changed a lot of things. Patients are coming with low testosterone, they're coming with high cholesterol. They are coming with things like blood clot and strokes. So the screening age will certainly continue to go down, and I would start screening patients as early as 30 years of age from both low testosterone. Cholesterol, coronary calcium scoring. And those who are high risk patients, whether they are diabetics or they are smokers, or they have strong family history or they have other risk factors, they should be aggressively screened. Um, as far as risk for cardiovascular disease, peripheral arterial disease that should be performed, um, at an early age. And what about stress tests in. So current guidelines says that if you are the the age of 39 or above, first thing they would screen is your cholesterol. And if your cholesterol, which is the bad cholesterol, LDL is on the high side, means it is running more than a hundred to 150. At that point, we recommend something called a coronary calcium. Coronary calcium score is a non-invasive test, which is done with a CAT scan, and they actually take into account the amount of calcium built up in your coronary arteries or the arteries around the heart. If the scores are high, which are graded between uh, zero to a hundred hundred to 3 99 and 400 and. In those patients, different guidelines are set to be done. If their calcium scores are very high, aggressive control of the cholesterol with statins is recommended. Otherwise, if their cholesterol is normal or is on the low side, then we do, uh, Coronary calcium score and based on the call calcium scores, we again recommend whether to treat with lifestyle modifications or not. Those who have a high coronary calcium scores, those they can be then referred for a stress test, whether it is an exercise stress test, or a nuclear stress test. That seems to be the common trend, uh, to do some preliminary screening and then based on the symptoms they would need further invasive. Cardiac CT is a very nice, non-invasive way, and if you have a low coronary calcium score cardiac CT in a young person under the age of 60, 65 is a good testing. Once they are above the age of 60 or 65, the natural buildup calcium in the coronary arteries is higher. So you may get a false positive with the um, uh, coronary CT in those patients. If they have symptoms, consider doing a nuclear stress test, or if they are really symptomatic with multiple risk factors, then go for a coronary angiography, which remains to be the gold standard. Now in patients with cardiac disease and blockages, cardiac stenting, and cardiac cats can be so invasive, but so necessary. However, with patients with e. Sometimes we are so lucky to catch them on the earlier end of it, that with shockwave therapy, which is completely painless, despite that scary name, we can have such great results chipping away at those blockages, at those plaques that men can often restore excellent blood flow with. That, that is correct. I think that is a very new, uh, non-invasive. Treating Ed in many patients where, especially atherosclerosis of the prude artery has been noted. And in those patients, if they have calcification, they're diabetics with low testosterone and they have early ed sharp with therapy is very good. Shock wave therapy. We also do it for coronary arteries. Uh, when the artery has got a lot of calcium and we are unable to deliver a stent, we use these, um, shock wave balloons. We put inside the coronary artery, break the calcium, and then we are able to successfully put in a balloon or a stent. Isn't that interesting? Except you do it a little differently than I do it That is correct. Yeah. You, you do it a little bit, lot less invasive. We do it very. Yes. And uh, it's such a great adjunct to what I do because I have so many men coming for erectile dysfunction from all over the world, and I think that this is such a great non-invasive way that helps function. It helps. Blood flow is just a really, really great tool that I have. And so many men around the world, millions are taking the little blue pill. Viagra and millions also take medications like ci. While these medications can help men, they don't actually solve the problem. But with shockwave therapy, we can often solve at least the structural problem with plaques. And given the fact that the number one cause of ED is blockages, these medications don't help with that at all. They're simply dilating the blood vessel so that more blood can flow around the blockage, Both Viagra and Cialis come with risks. Yes, absolutely. These pills, as you said correctly, that the basic problem with the ED is an obstructive. Blockage in the prudent artery, which then leads to the problem. By using these, uh, medications, we are just temporarily increasing the flow, but the blockage where it is, the flow does not really improve. So you may see a very temporary release, uh, and, uh, of the spasm or increase in the blood. but it would not be a permanent solution for that. And number two, these patients can be on some other heart medications. And taking these drugs can cause an abrupt lowering of your blood pressure and is in black box warning for patients who are on nitrate because literally it can kill them. why is performing? You wanna know something interesting? I have seen this during my ER career. Men would come. Literally having had MIS during sex because they would be on these medications, Viagra, whichever one, and you know, if they wanna sue me, they can sue me. It'll just make me more famous. the reality is what it is. That is a very good observation you made. And these drugs are very temporary solution, uh, especially older patients, uh, like to, uh, take it because, but the older patients are also the patients who have coronary artery disease and they're on multiple medications. So interaction with these medications tends to be sometimes very serious side effects and sometime even fatal side effects can. So cautious use of these medications in older patients. Same for the younger patients. They need to get to the bottom of the problem, whether it is related to low testosterone or actual blockage of the artery, um, which should be treated first rather than just trying these, uh, medications. Yes. And in fact I have a nitric oxide booster as part of the Dr. Sex very line of supplements. I also have a testosterone booster because I feel that these are, so Im. To good erectile function. You have to have good blood flow with the nitric oxide and you have to have good testosterone levels. And we do regular hormone therapy with creams and shots and everything, but some men don't want to be on that. They want to improve their levels naturally. So at least now we also have that option available for them. Yes. For a good performance of an engine, just like you need a good oil, the good filter. In case of a good performance for men in the bedroom, you need all these, including a good testosterone level and clean pipes and no blockages. Absolutely. So Dr. Mohanty coming back to testosterone, it's really getting a bad reputation nowadays. The anti hormone lobby saying, oh, this is terrible. This is actually not good. It's not natural. It's got so many side effects. What do you have to say to that? That is one of the most interesting questions in through this meeting. The bad propaganda on testosterone, but testosterone. If it is a bad hormone, we would not have had it in our body. We need testosterone for normal functioning, especially for young men. It is very, very, I. not only for sex, but also for muscle building, clean thinking, focusing good night's sleep. Lack of these hormones would lead them to something called andropause, very similar to females called menopause. So hence for the role of testosterone remains very controversial. Patients who tend to have normal testosterone and they are using it to bump up their testosterone so that they can do more muscle building. And they can do better in the sex is something which we do not encourage because those are the patients who will have the side effect from the testosterone having increased risk of stroke, heart attack, et cetera. Those patients who tend to have low testosterone and they are younger patients, they actually do the most benefit for those patients. Having a testosterone level normal in the range of 500 to 700 up to 800 makes them think clearly, focus, performance. Every which way as well as muscle building, but without increasing the risk of stroke and heart attack. This has all been clinically studied as well as, uh, many papers and research articles have come out on it. So the bottom line is used testosterone therapy and boosters for patients who are young and they have low T levels and they want to get into a normal homeostasis for their body. Avoid using testosterone in older patients. And patients who have normal testosterone for body building, anabolic steroid purposes, or to enhance their sex drive, I do not recommend in those patients. And those are the ones who, who will have the side effects and then will ultimately bring in bad propaganda. I am using testosterone in a lot of men and I am using it in some older men, but of course I am monitoring their levels very closely and I. Overmedicating them. A big problem I'm noticing is that all these websites have come up where they don't even know who they're talking to, and they have no real doctor associated with the website. It's just a corporation, and I think a lot of damages being done by these websites because they're not really monitoring these patients like they should. A little bit of testosterone can go a long. Absolutely a hundred percent agree to. There are many of these companies who have started testosterone therapy as they see it is a big market. So they are using testosterone therapy for any kind of patient who walks in and they say they have testosterone is low or they feel low normal, they feel low, uh, energy. And without a real supervision of a physician. We've been administered by many, uh, allied healthcare, uh, professionals and sometimes they don't even follow the level. And very interestingly, since you brought that up, I actually have few patients who have gone to these, uh, clinics, and I'm not going to name. They actually had Frank heart. and cardiac arrest. We had to revise them, clean the clot out of their, uh, blood vessels. And some of them even needed stents, et cetera. But they made it and purely by the fact that they were doing testosterone therapy completely unsupervised in these places. which finally led to the. So you need to have a good physician who knows what they are doing. They're checking their blood levels very closely, they're not very aggressive on, on the treatment, and, uh, prevent a catastrophic outcome like that, which I have experienced many times in my practice. It's really sad because testosterone is not the enemy, I think substandard medical care is so, I think testosterone, absolutely. You know, testosterone is a good thing. That's why, like you said, we have it, but thank you so much for this discussion and for taking time out of your busy day. You are in your office right now and I'm at mine, so thank you for doing this for us and our listeners. And how can people find you for cardiac consultations? people can definitely find it, uh, through our website. It's Advanced Cardiovascular Consultants and we have three offices in. County of, uh, Palm Beach and West Palm, Palm Beach Gardens and Jupiter. We have a very nice website. They can, go in there. We have a patient popup also where they can sign up and can get appointments. Thank you so much once again for coming. This has been such a great conversation. Thank you for having me on the podcast and to my listeners, I am sure you learned so much from Dr. Mahany today. I am definitely going to invite him back on the podcast. So make sure you submit your questions to me. You can always email them to ask me@drsexferry.com. So let's just end with this idea. If your penis isn't working very well, think about your heart first. Until next time.