Does heart problems cause erectile dysfunction? Yes, cardiovascular disease and erectile dysfunction (ED) are closely linked through shared vascular mechanisms. Research shows that 40–70% of men with heart disease experience some degree of ED, with both conditions often stemming from endothelial dysfunction and impaired blood flow. Importantly, ED frequently appears before other cardiac symptoms, potentially serving as an early warning sign of underlying cardiovascular disease. The penile arteries are smaller than coronary vessels, making them vulnerable to early atherosclerotic changes. Recognising this connection is vital—ED should prompt cardiovascular assessment, not dismissal as merely an ageing concern.

The Link Between Heart Problems and Erectile Dysfunction

Erectile dysfunction (ED) and cardiovascular disease share a significant and well-established connection. Research demonstrates that men with heart problems are more likely to experience erectile difficulties, with studies suggesting that 40-70% of men with cardiovascular disease report some degree of ED, increasing with age and disease severity. This relationship exists because both conditions share common underlying mechanisms, particularly endothelial dysfunction and impaired blood flow.

The vascular system plays a crucial role in achieving and maintaining an erection. When a man becomes sexually aroused, the arteries supplying the penis must dilate to allow increased blood flow into the erectile tissue. This process requires healthy, flexible blood vessels with properly functioning endothelial cells—the inner lining of arteries. Heart disease and ED often stem from the same pathological processes that damage these blood vessels, including atherosclerosis (hardening and narrowing of the arteries), hypertension, and inflammation.

Importantly, erectile dysfunction frequently appears before other cardiovascular symptoms become apparent. The penile arteries are smaller than the coronary arteries supplying the heart, making them potentially more vulnerable to early atherosclerotic changes. Research suggests that men with ED but no cardiac symptoms have an increased risk of developing cardiovascular events within 2-5 years.

Recognising this connection is vital for both patients and healthcare professionals. ED should not be dismissed as merely a quality-of-life issue or an inevitable consequence of ageing—it may signal underlying cardiovascular disease requiring investigation and management to prevent serious cardiac events. While vascular causes are common, other factors including hormonal imbalances, neurological conditions, psychological factors, and medication side effects can also contribute to erectile dysfunction.

How Cardiovascular Disease Affects Erectile Function

The mechanism linking cardiovascular disease to erectile dysfunction centres on vascular health and blood flow regulation. Atherosclerosis, the primary pathological process in cardiovascular disease, involves the accumulation of fatty plaques within arterial walls. These plaques narrow the vessel lumen, reducing blood flow and impairing the arteries' ability to dilate in response to physiological signals. When this process affects the pudendal and cavernosal arteries supplying the penis, it directly compromises erectile function.

Endothelial dysfunction represents another critical pathway. The endothelium produces nitric oxide (NO), a crucial signalling molecule that causes smooth muscle relaxation in arterial walls and erectile tissue. In cardiovascular disease, endothelial cells become dysfunctional, producing less nitric oxide and more vasoconstrictor substances. This imbalance prevents adequate arterial dilation and blood flow into the corpora cavernosa—the erectile chambers of the penis—making it difficult to achieve or sustain an erection sufficient for sexual intercourse.

Hypertension contributes to erectile dysfunction through multiple mechanisms. Chronically elevated blood pressure damages the delicate endothelial lining of blood vessels, accelerates atherosclerosis, and causes arterial stiffening. Additionally, some antihypertensive medications may independently contribute to erectile difficulties. Older non-selective beta-blockers and thiazide diuretics are more commonly associated with ED, while ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers generally have less impact on sexual function.

Reduced cardiac output in heart failure also affects erectile function. When the heart cannot pump blood efficiently throughout the body, peripheral circulation—including to the genitals—becomes compromised. Furthermore, the physical deconditioning, fatigue, and breathlessness associated with heart failure can reduce sexual desire and performance. The psychological burden of living with cardiovascular disease, including anxiety and depression, compounds these physical factors, creating a multifaceted impact on sexual health. NHS Talking Therapies can provide support for these psychological aspects.

Common Heart Conditions That May Cause Erectile Dysfunction

Coronary artery disease (CAD) represents the most prevalent cardiac condition associated with erectile dysfunction. The same atherosclerotic process that narrows coronary arteries affects peripheral and penile vessels. Men with CAD frequently report ED, and conversely, men presenting with ED have a substantially elevated risk of having undiagnosed coronary disease. NICE Clinical Knowledge Summary (CKS) guidance recognises this connection and recommends cardiovascular risk assessment for men presenting with erectile dysfunction.

Hypertension affects erectile function both directly through vascular damage and indirectly through medication effects. Uncontrolled high blood pressure damages arterial walls, promotes atherosclerosis, and impairs endothelial function. Studies indicate that approximately 20-30% of men with hypertension experience erectile dysfunction, with prevalence increasing alongside blood pressure severity, duration, and age. However, it's important to note that effective blood pressure control, even with medication, generally improves overall vascular health and may benefit erectile function in the longer term.

Heart failure significantly impacts sexual function, with research showing that many men with chronic heart failure report erectile difficulties. The reduced cardiac output, decreased exercise tolerance, and systemic effects of neurohormonal activation all contribute to ED. Additionally, many heart failure medications, whilst essential for managing the condition, may affect sexual function as a secondary consideration.

Atrial fibrillation and other arrhythmias may be associated with erectile dysfunction, though the relationship is less direct than with other cardiac conditions. The connection likely relates to shared risk factors (age, diabetes, obesity, hypertension) and the overall cardiovascular disease burden rather than the rhythm disturbance itself. Valvular heart disease, particularly when causing significant haemodynamic compromise, can also affect erectile function through reduced cardiac output and systemic perfusion.

Previous myocardial infarction (heart attack) frequently precedes the development or worsening of erectile dysfunction, both through the physical vascular damage and the psychological impact of the cardiac event. Many men experience anxiety about sexual activity following a heart attack, fearing it may trigger another event, though this concern is often disproportionate to the actual risk in stable, rehabilitated patients.

When to Seek Medical Advice for Both Conditions

Men experiencing erectile dysfunction should seek medical evaluation, particularly if ED develops suddenly or progressively worsens. Given the established link between erectile dysfunction and cardiovascular disease, ED warrants assessment beyond sexual health concerns. NICE recommends that healthcare professionals evaluate cardiovascular risk factors in men presenting with erectile dysfunction, as it may represent the first manifestation of systemic vascular disease.

You should contact your GP promptly if you experience erectile dysfunction alongside any of the following symptoms:

• Chest pain, pressure, or discomfort, particularly during physical exertion or sexual activity

• Unexplained breathlessness or reduced exercise tolerance

• Palpitations or irregular heartbeat

• Dizziness, light-headedness, or fainting episodes

• Leg pain when walking that resolves with rest (intermittent claudication)

• Sudden onset of erectile dysfunction, especially in younger men without obvious risk factors

• An erection that lasts more than 4 hours (priapism) – this requires urgent medical attention

If you have known cardiovascular disease and develop new or worsening erectile dysfunction, inform your cardiologist or GP. This change may indicate disease progression or medication effects requiring review. Never discontinue prescribed cardiac medications without medical supervision, even if you suspect they contribute to erectile difficulties—alternative management strategies can often be implemented whilst maintaining essential cardiovascular protection.

Your GP will typically assess your cardiovascular risk (using tools such as QRISK3), check your blood pressure, and may arrange blood tests to check glucose/HbA1c, cholesterol levels, and possibly morning testosterone if you also have reduced libido.

For men with established heart disease considering treatment for erectile dysfunction, medical consultation is essential before using phosphodiesterase-5 (PDE5) inhibitors such as sildenafil, tadalafil, or vardenafil. These medications are contraindicated in patients taking nitrate medications or nicorandil for angina, and in those taking riociguat for pulmonary hypertension. They should also be used with caution in men taking alpha-blockers for hypertension or prostate conditions. Your doctor will assess whether ED treatment is safe given your cardiac status and current medications.

Seek immediate emergency care (call 999) if you experience chest pain, severe breathlessness, or loss of consciousness. These symptoms require urgent evaluation regardless of any connection to sexual activity or erectile dysfunction concerns.

Treatment Options: Managing Heart Health and Erectile Function

Addressing erectile dysfunction in men with cardiovascular disease requires an integrated approach that prioritises cardiac health whilst considering sexual function. The foundation of management involves optimising cardiovascular risk factors through lifestyle modifications and appropriate medical therapy. These interventions benefit both conditions simultaneously, as improving vascular health enhances erectile function whilst reducing cardiovascular risk.

Lifestyle modifications represent first-line management and include:

• Regular physical activity: The UK Chief Medical Officers and NHS recommend at least 150 minutes of moderate-intensity aerobic exercise weekly, plus strength activities on 2 days per week, which improves endothelial function, cardiovascular fitness, and erectile function

• Smoking cessation: Tobacco use significantly worsens both cardiovascular disease and ED through vascular damage and endothelial dysfunction

• Weight management: Obesity contributes to both conditions; even modest weight loss (5–10% of body weight) can improve erectile function

• Dietary modifications: A Mediterranean-style diet rich in fruits, vegetables, whole grains, and healthy fats supports vascular health

• Alcohol moderation: Excessive alcohol consumption impairs erectile function and cardiovascular health

• Stress management: Psychological factors significantly impact both cardiac and sexual health

Pharmacological treatment for erectile dysfunction must be carefully considered in the context of cardiovascular disease. PDE5 inhibitors (sildenafil, tadalafil, vardenafil) are generally safe and effective for men with stable cardiovascular disease, provided they are not taking nitrate medications or nicorandil (absolute contraindications) or riociguat (contraindicated). Caution is needed when used with alpha-blockers, with specific timing recommendations to avoid blood pressure drops. These drugs work by enhancing nitric oxide signalling, promoting arterial dilation and blood flow to erectile tissue. Your cardiologist or GP will assess your cardiovascular status, including exercise tolerance and medication regimen, before prescribing these treatments.

For men unable to use PDE5 inhibitors, alternative options include:

• Vacuum erection devices: Mechanical devices that draw blood into the penis using negative pressure

• Alprostadil: Available as intracavernosal injections (Caverject) or intraurethral preparations (MUSE) in the UK

• Penile prosthesis: Surgical implants for refractory cases

Optimising cardiac medications may improve erectile function. If your current antihypertensive regimen includes older beta-blockers or thiazide diuretics, your doctor might consider switching to alternatives with less impact on sexual function, such as ACE inhibitors, angiotensin receptor blockers, or calcium channel blockers, provided these are appropriate for your cardiac condition. However, never adjust cardiac medications without medical supervision.

Cardiac rehabilitation programmes benefit both cardiovascular and sexual health. These structured programmes combine supervised exercise, education, and psychological support, improving physical fitness, confidence, and quality of life. Many men find that improved cardiovascular fitness through rehabilitation enhances their erectile function and confidence in resuming sexual activity.

Psychological support, including counselling or cognitive behavioural therapy, addresses the anxiety, depression, and relationship difficulties that often accompany both cardiovascular disease and erectile dysfunction. The NHS provides access to psychological therapies that can complement medical management, addressing the emotional and relational dimensions of these interconnected conditions.

If you experience any suspected side effects from medications, report them to the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk).

Frequently Asked Questions