Do Erection Problems Foretell Heart Problems?

Arginine Is Hard to Beat

Do Erection Problems
Foretell Heart Problems?

They could be an early warning sign of
atherosclerosis and coronary artery disease
By Will Block

"You’ll have to ask someone older than me."
— Eubie Blake, at age 97, when asked
when the sex drive peters out

ravo, Eubie—that’s the spirit! What if, however, as the old saying goes, the spirit is willing but the flesh is weak? It happens—and not just to centenarians. Although impotence (erectile dysfunction to the politically correct) is primarily a disorder of old age, the middle-aged are by no means immune, and even young bucks can be afflicted. Sometimes there are psychological reasons (stress, anxiety, guilt, etc.), but in the vast majority of cases, there is an organic (i.e., physiological) reason for the problem.*

*It’s estimated that impotence afflicts up to 30 million American men and about 100 million men worldwide. Think about that: with only about 5% of the world’s population, we have about 30% of the impotence! What does that tell you about our state of health?

And what a problem it is, if you’re the one affected. It can severely damage your self-image, and men take that sort of thing very much to heart. Something else they should take to heart is the knowledge that impotence can be a harbinger of something even worse, namely, heart disease. But why? What could the heart and penis possibly have in common? One word: arteries.

Beware of Penile Artery Disease

Like every other organ, the heart requires a blood supply to nourish its cells. That blood is delivered by the coronary arteries, which are pretty narrow and thus easily clogged by atherosclerotic plaque. The resulting compromise in their ability to deliver adequate blood upon demand (i.e., during exertion, including sexual intercourse) can result in the heart pain called angina pectoris. The worse the obstruction, the more severe the potential consequences, including heart attack and stroke.

Downstairs, there is also a demand for extra blood from time to time, and if it’s not forthcoming because the penile arteries (which are even narrower) are not up to the task, there is again pain, albeit of an emotional, not physical, nature. But why would the blood not be forthcoming? We all know about coronary artery disease, but surely there’s no such thing as penile artery disease—is there? There sure is, and perhaps if it were called by that name, men would take the threat more seriously and make wiser lifestyle choices, such as eating a healthier diet, getting plenty of exercise, and not smoking.

Arginine Produces NO, which Dilates Blood Vessels, which . . .

They might also choose to supplement with the nutrient amino acid arginine, which plays a vital role in vasodilation, the process by which arteries dilate, allowing blood to flow more freely, at a lower pressure. This is accomplished by arginine’s release of the gaseous signaling molecule nitric oxide (NO) in our arteries. Without NO, there would be no erections (but NO erections are good erections). Thus arginine has a prosexual effect—in women as well as men, because ample blood flow to the genitals is also essential for female sexual arousal and satisfaction. Because of its ability to facilitate erections, arginine is a viable alternative to Viagra® and its competitors, Levitra® and Cialis®. (See the sidebar “Could Drugs Make You Go Blind?”)

Could Drugs Make You Go Blind?

Remember those scare stories about what would happen to boys if they masturbated? They would grow hair on their palms, go blind, etc. (All things considered, isn’t it remarkable how few hairy-palmed boys there are?) Blindness is no joking matter, of course, and in a strange twist of fate, this specter has been raised again in the sexual arena. This time it has to do with the prescription drugs for impotence that are currently on the market: Viagra, Levitra, and Cialis.

In October 2005, the U.S. consumer advocacy group Public Citizen (of which we are no great fans, because of its hostility to the supplements industry) filed a legal petition for the FDA to require stronger warnings on the packaging for all three of these drugs, because of some cases of blindness that have been attributed to them.1 Although rare, this side effect is so horrendous that it merits serious concern. Indeed, the drug manufacturers in question had already added warnings to their labels earlier in the year, but Public Citizen wants them to be “black-box warnings,” making them clearer and more visible.

They have also requested that the pulmonary hypertension drug Revatio, which has the same active ingredient (sildenafil) as Viagra, carry a similar black-box warning—the strongest warning the FDA can require. As the accompanying article makes clear, it’s no accident that the same drug molecule is useful for both impotence and cardiovascular disease. That is true of the amino acid arginine as well.

The men most at risk of blindness from the use of prescription impotence drugs, by the way, are those older than 50 who have diabetes, heart disease, high blood pressure, and high cholesterol, among other ailments.


  1. Heavey S. Impotence drugs need stronger warning—U.S. group. Reuters Health Information, Oct. 20, 2005.

Nitric oxide plays a primary role in regulating blood pressure, and the importance of arginine is not that it’s a source of NO in our bodies, but that it’s the source of NO. It’s no coincidence that this compound is vital not just for proper sexual function but also for proper cardiovascular function. Both depend critically on endothelium-dependent vasodilation, i.e., vasodilation that originates in the endothelium, the layer of smooth, flat, tightly packed cells that line the inner walls of the blood vessels and the heart, overlying the smooth-muscle cells. The NO molecules released by arginine in endothelial cells migrate to the smooth-muscle cells, where they exert a relaxing effect; this allows the blood vessels to dilate.

Arginine has a prosexual effect—in
women as well as men, because
ample blood flow to the genitals is
also essential for female sexual
arousal and satisfaction.

Decreased bioavailability of NO is a key feature of all the risk factors for atherosclerosis.1 By enhancing the release of NO, supplemental arginine improves endothelium-dependent vasodilation in people with those risk factors—such as high cholesterol, high blood pressure, smoking, and aging—and in patients with coronary artery disease, microvascular angina pectoris (heart pain caused by constriction of the coronary microvasculature), and peripheral arterial disease.2 The vasodilation helps to alleviate the symptoms of these diseases—as it does the problem of impotence.

Heart and Penis—Linked by Risk

This brings us to an intriguing observation: men who have coronary artery disease (CAD) are more likely than heart-healthy men to suffer from impotence, and vice versa. This reciprocal risk relationship between the two age-related disorders has been known for several years, although it had long been suspected. (See “Take Arginine to Heart” and “Healthy Arteries—Good for the Heart, and Another Part” in the February 2004 and June 2004 issues, respectively.) Until recently, however, little was known about impotence as a risk factor for CAD in men who had no symptoms of that disease.

To address this question, researchers in Italy conducted a study to assess the prevalence and extent of CAD (specifically, atherosclerosis) in asymptomatic men with “vascular erectile dysfunction,” i.e., impotence caused by problems in the penile arteries.3 They studied 70 men with clinically diagnosed impotence of moderate severity and 73 healthy men (the controls) who were matched in terms of age, race (all were Caucasian), and coronary risk score. (Impotence is defined, by the way, as the recurrent or persistent inability to achieve and maintain an erection of sufficient strength and duration to accomplish satisfactory sexual intercourse.)

Impotence Is a Risk Factor for Coronary Artery Calcification

None of the men (average age 51) had a history of cardiovascular disease, and they had no overt symptoms. But what about covert symptoms—the ones that must be ferreted out with sophisticated tests? It turned out that the impotent men had significantly poorer results than the controls in all three of the tests used:

  • High-sensitivity C-reactive protein: This protein, a beta-globulin produced by the liver, is a marker for systemic inflammation and a reliable predictor—better than LDL-cholesterol, in the opinion of some scientists—of heart disease and cardiac events. The higher the CRP level, the greater the risk.
  • Flow-mediated dilation: In this test of arterial function, the researchers measured the ability of the brachial artery (the main artery of the arm) to dilate in response to an artificially induced drastic change in blood flow and blood pressure. A quick, strong response indicates a healthy artery.
  • Coronary artery calcification: Calcium deposits in the coronary arteries can cause not only obstruction of blood flow but also a hardening of the arterial walls, making them less able to dilate properly in response to NO or other factors. The deposits, which occur in the form of calcium salts normally found only in bone and teeth, can be seen and measured by multi-slice computed tomography (MSCT).

The results for coronary artery calcification (CAC) were particularly troubling: CAC occurred at a significantly younger age in the impotent men than in the controls, and the rate of increase in the prevalence of CAC with age was significantly higher. Overall, the impotent men were 6.4 times more likely to have high levels of CAC than the controls.

The results for coronary artery
calcification (CAC) were particularly
troubling. Overall, the impotent men
were 6.4 times more likely to have
high levels of CAC than the controls.

Impotence Predicts Heart Disease Independently of Traditional Risk Factors

The main findings of this study were that both the prevalence and the extent of asymptomatic coronary artery disease were significantly higher in impotent men than in healthy men and that impotence predicted the disease independently of traditional risk factors, such as high cholesterol, high blood pressure, smoking, or diabetes. The authors stated,

These data suggest that ED [erectile dysfunction] may be the earliest manifestation of a generalized vascular disease and that these patients may be at an increased risk of later developing CAD. . . . On the basis of current knowledge of erectile physiology, the close relation between ED and coronary disease does not represent a surprise. Indeed, ED is often an expression of endothelial dysfunction, an early event in the atherosclerotic process.

They go on to suggest that the penis may be a more sensitive indicator of systemic disease because of the smaller diameter of the penile arteries than the coronary arteries. That makes sense—a garden hose is easier to plug than a fire hose.

Eubie Blake
A Most Unusual Barometer

Men, the next time you look at your penis, try to imagine it as a kind of barometer for your heart. If there are any problems down there (and we hope there aren’t), remember that similar problems might be developing upstairs, with consequences that are potentially much more serious. Don’t hesitate to talk to your doctor about it, and take all the measures you can to avoid further damage.

Perhaps it’s fitting to end this article with another quote from Eubie Blake. On his 100th birthday, he said,” If I’d known I was gonna live this long, I’d have taken better care of myself.” Witty to the end, he died five days later.

The Benefits of Vitamin C and Rhodiola rosea

When nitric oxide molecules are produced from arginine, they don’t accumulate for use later on. NO is a highly reactive molecule—it’s a free radical, in fact (but an essential one)—that exists only briefly in our bodies before being consumed by the chemical reactions it undergoes. Thus, it must be synthesized constantly, but at varying rates to meet the physiological demands of the moment.

The two factors that limit the bioavailability of this volatile compound in our arteries are decreased synthesis of NO on the one hand, and increased inactivation of NO on the other. The latter is brought about mainly by two types of oxidative stress: the presence of reactive oxygen species (ROS), which include many destructive free radicals, and the presence of oxidized low-density lipoprotein (LDL), which is a major culprit in the formation of atherosclerotic plaque. Both of these factors are present in coronary artery disease (CAD), and both can be suppressed (but not eliminated) by antioxidants, such as vitamin C.

This suggests that vitamin C might be able to improve the arginine-induced vasodilation of coronary arteries in patients with CAD and stable angina (the latter being a clear indication of significant obstruction in the arteries). Greek researchers have investigated this question, using the rather drastic method of infusing both arginine and vitamin C solutions directly into the coronary arteries, which they then analyzed using angiography.1 They concluded, first of all, that arginine alone significantly dilated the patients’ arteries. When very high concentrations of vitamin C were added, the effect was enhanced, indicating that NO was being protected from inactivation. That’s interesting, but whether any such effect would be seen with oral administration of arginine and vitamin C is impossible to say.

In Russia, meanwhile, researchers were investigating a different problem associated with cardiovascular disease: inflammation in the endothelium, which is a major factor in the development of atherosclerotic plaque.2 Of the different kinds of agents that have anti-inflammatory properties, one that has attracted attention in recent years is the herb Rhodiola rosea, also known as golden root, which has a long history of use in Asia and Europe.

The Russian researchers gave a group of healthy young adults extracts of R. rosea or placebo before subjecting them to a regimen of exhausting physical exercise, which would be expected to produce inflammatory muscle damage. The volunteers who had received the R. rosea extracts showed much smaller increases than the controls in their blood levels of C-reactive protein (CRP) and creatine kinase, both of which are markers of inflammatory muscle damage.

The researchers speculated that “Two promising trends in the use of R. rosea extract can be outlined: facilitation of recovery after exercise and decrease of the risk of cardiological disorders.” [For a more extensive discussion of this study (which was, unfortunately, poorly documented and therefore unreliable) and of the significance of CRP in heart disease, see Rhodiola rosea May Be Good for Your Heart” in the February 2005 issue.]


  1. Tousoulis D, Xenakis C, Tentolouris C, Davies G, Antoniades C, Crake T, Stefanadis C. Effects of vitamin C on intracoronary L-arginine dependent coronary vasodilation in patients with stable angina. Heart 2004;91:1319-23.
  2. Abidov M, Grachev S, Seifulla RD, Ziegenfuss TN. Extract of Rhodiola rosea radix reduces the level of C-reactive protein and creatine kinase in the blood. Bull Exp Biol Med 2004;138(7):63-4. [Transl from Russian]


  1. Tousoulis D, Antoniades C, Stefanadis C. Nitric oxide in coronary artery disease: effects of antioxidants. Eur J Clin Pharmacol 2005 [online preprint].
  2. Tousoulis D, Xenakis C, Tentolouris C, Davies G, Antoniades C, Crake T, Stefanadis C. Effects of vitamin C on intracoronary L-arginine dependent coronary vasodilation in patients with stable angina. Heart 2004;91:1319-23.
  3. Chiurlia E, D’Amico R, Ratti C, Granata AR, Romagnoli R, Modena MG. Subclinical coronary atherosclerosis in patients with erectile dysfunction. J Am Coll Cardiol 2005;46:1503-6.

The Benefits of Arginine

For those who desire healthy blood vessels in all parts of their bodies, Life Enhancement recommends arginine in the form of a drink mix that also contains the antioxidant vitamins C and E, as well as choline (a precursor to the neurotransmitter acetylcholine) and its cofactor pantothenic acid (vitamin B5), which help to potentiate some of arginine’s biological effects.

The generally recommended serving sizes for maximum benefit are 18 g/day of arginine for men and 12 g/day for women, preferably taken all at once on an empty stomach, about an hour before exercise or athletics or sexual activity, or at bedtime. This optimizes the release of growth hormone by the pituitary gland, which is stimulated by arginine, and provides NO-mediated vasodilation when it is most needed.

For supporting proper cardiovascular function, it’s preferable to take half the maximum amount of arginine and to divide the daily serving into three portions of 3 g (for men) or 2 g (for women) each. The totals are then 9 g/day for men and 6 g/day for women. It’s best to drink the three portions at midmorning, midafternoon, and bedtime so as to avoid conflict with protein-containing meals.

For those who wish to enhance their cardiovascular health and improve their ability to cope with fatigue and the stresses of daily life, Life Enhancement recommends an extract of Rhodiola rosea, or “golden root.” This is a safe herbal product whose adaptogenic properties have made it popular for centuries in Europe and Asia.

Will Block is the publisher and editorial director of Life Enhancement magazine.

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