The relationship between erectile dysfunction and high cholesterol

Erectile dysfunction is a problem that affects millions of men in the United States. 

It sometimes happens in young men, primarily due to psychogenic problems. 

But the most commonly affected population includes seniors and sometimes men in their midlife. 

Males who constantly have erection problems should evaluate their sexual health regardless of their age. However, it is particularly relevant to do so if they have high cholesterol levels. But why is that? How do high cholesterol and erectile dysfunction relate to each other?

What are high cholesterol levels for men?

Cholesterol is an essential component of the lipid membrane in our cells. It is also used to create steroid hormones. 

We can’t live without cholesterol, but the problem is that we often get too much of it. Saturated fat increases cholesterol levels, and it is found in almost every food in the Western diet. Thus, there’s an upper threshold for cholesterol levels in men. Vascular disease is more common when such numbers are exceeded.

Your total cholesterol levels are normal in a lipid panel, below 200 mg/dL. You have a borderline high cholesterol level when it reaches 200-239 mg/dL. More than that is considered a high level, and it is a risk factor for cardiovascular disease.

However, cholesterol is carried in the blood by large carriers called lipoproteins. They are like sacs of fatty acid traveling in the blood, and we have many types. 

Each type behaves differently, which is why we have the so-called good cholesterol and bad cholesterol. LDL cholesterol, sometimes tagged as bad cholesterol, should always stay below 100 mg/dL in healthy males. But males with heart disease or high blood pressure should keep their levels below 70 mg/dL.

HDL cholesterol, also known as good cholesterol, should be at least 60 mg/dL. A higher concentration is usually a good sign of cardiovascular health. This is because good cholesterol cleans the body from excess fatty acids while bad cholesterol distributes fatty acids, sometimes contributing to atherosclerosis.

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The relationship between cholesterol and erectile function

Atherosclerosis is the main link between cholesterol levels and erectile function. LDL cholesterol is tagged as bad or unhealthy because this lipoprotein delivers cholesterol to every cell in the body. 

This is a good thing in healthy individuals because every cell needs cholesterol to replicate. However, a high level of this lipoprotein causes an excessive delivery of cholesterol.

When too much cholesterol is being delivered to the tissues, and they no longer need this fatty acid, it is accumulated in the blood vessels. It only takes an inflammatory trigger in the blood vessel wall, and accumulated cholesterol becomes atherosclerotic plaque. 

These plaques are formed by oxidized LDL cholesterol particles, macrophages, and other proteins. They are compact and behave like clogs in the pipeline that reduce the blood flow. This causes heart disease and may even trigger a heart attack or stroke when the plaque breaks.

In the penis tissue, blood flow is fundamental for erectile function. Thus, we can have erectile issues in case of atherosclerosis in the pelvic blood vessels. 

The blood flow reduces, now unable to fill the cavernous bodies with pressured blood. If an erection happens, it won’t be very hard, and it may disappear after a short while.

Can high cholesterol cause erectile dysfunction?

The above is only the theory, but does it happen in real life? Is it true that high cholesterol causes atherosclerosis in the penile arteries, and these plaques trigger erectile dysfunction?

This question was answered in a study published in the journal Nature. The investigators evaluated the lipid profile of healthy patients and others with erectile dysfunction (ED). 

They reported that people with ED symptoms are more likely to have high LDL cholesterol levels. They suggested that hyperlipidemia should be fixed along with erectile dysfunction for a complete recovery of erections (1).

Over the years, scientific findings continue suggesting that many cases of ED are caused by atherosclerosis. One of the most recent pieces was also published by the journal Nature

It evaluated a fraction of the electrocardiogram called QRS waves. They found abnormalities in the QRS waves in patients with ED, indicating that erectile dysfunction is linked to atherosclerosis and cardiovascular problems. 

Moreover, the authors recommended including electrocardiogram studies in ED patients before prescribing PDE5 inhibitors, even if they don’t have heart issues because ED is considered an early predictor of atherosclerosis (2).

The relationship also works in reverse. Male patients with cardiovascular, endothelial dysfunction, and atherosclerosis are more likely to suffer from erectile dysfunction. 

A multi-ethnic study published in the American Journal of Hypertension showed that cardiovascular health predicts future erectile dysfunction regardless of race. 

In the study, patients with better cardiovascular health only had 33% of ED. The proportion of ED was almost double in patients with poor cardiovascular health (58%) (3).

Conclusion

There’s a link between high cholesterol and erectile dysfunction. Patients with erection problems should also evaluate their cardiovascular risk. 

It is common to find comorbidities such as diabetes, heart problems, and coronary heart disease in such patients. In most cases, the link between both health problems is atherosclerosis.

Patients with high cholesterol levels accumulate fatty acids in their blood vessels. A plaque forms and creates a clog that reduces the blood flow. These plaques are usually found throughout the body and may affect heart function and cause sexual dysfunction simultaneously.

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Sources

  1. Nikoobakht, M., Nasseh, H., & Pourkasmaee, M. (2005). The relationship between lipid profile and erectile dysfunction. International journal of impotence research, 17(6), 523-526. https://www.nature.com/articles/3901350
  2. Karabakan, M., Bozkurt, A., Saylam, B., Kucuksu, Z., Hirik, E., & Aktas, B. K. (2020). A new proof for the relationship between erectile dysfunction and atherosclerosis: fragmented QRS?. International journal of impotence research, 32(3), 302-307. https://www.nature.com/articles/s41443-019-0166-3
  3. Lane-Cordova, A. D., Kershaw, K., Liu, K., Herrington, D., & Lloyd-Jones, D. M. (2017). Association between cardiovascular health and endothelial function with future erectile dysfunction: the multi-ethnic study of atherosclerosis. American journal of hypertension, 30(8), 815-821. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861595/

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