Dying suddenly of a heart attack during active old age is not a bad prospect in general. But dying during one's productive middle years or the promising early years is something else. Even here, however, the notion of heart attacks or strokes as unexpected bolts from the blue is losing ground to the evidence.
It takes years to have a heart attack, and during those that precede the event there's usually a progressive loss of energy and vigor, including sexual potency, as recent French studies reveal. They were undertaken in Paris over a four-year period and demonstrated how the same risk factors for narrowing blood vessels and reducing circulation to the heart are operative elsewhere in the body, compromising in particular circulation to the male genitalia.
A Factor in Impotence
Artery narrowing is not considered a common cause of impotence, but among more than 400 impotent men it accounted for an overall incidence of 30%. Among a large subgroup of those with non-psychological erection failures, artery narrowing accounted for half of all cases. Using new ultra-sound techniques because the vessels are extremely small, the French clinicians were able to study artery pressure differentials as indicators of narrowing, to remind us from their studies that hardening of the arteries affects all parts of the body, not simply the heart and brain.
All the impotent men evaluated had at least three of these recognized artery-narrowing risk factors, the kind that lead to heart attacks: high blood cholesterols, high blood pressures, blood sugars and cigarette smoking. Among those men in whom there was demonstrated evidence of artery narrowing, half were cigarette smokers, a third had unrecognized diabetes, and a third had elevated blood cholesterols. In fact, whenever impotent men had arterial narrowing, all of them had at least three of the four heart attack risk factors.
It's well-recognized that men with major impairment of circulation to their legs, a condition called intermittent claudication, usually complain of impotence, but in the French study only 10% of the men evaluated had significant hardening and narrowing of the vessels to their legs. Routine autopsy studies these days disclose blood vessel narrowing in the system servicing the male genitalia, a finding that has awakened little general interest because it's not in a life-threatening location like the heart or brain. The Kinsey Report on male sexual behavior more than 25 years ago indicated increased impotence after the age of 40, in fact one-third of men over 50 reported themselves impotent at that time.
The French study suggests that half the impotence in the middle years is due to arterial narrowing. Ironic, isn't it, that the hardening that characterizes erectile tissue performance because it is blood-flow dependent is compromised by the hardening that interferes with blood-flow delivery? Declining potency in the middle years could be an early symptom of vascular disease. Such men should begin following programs recommended for established coronary artery disease. Their impotence is likely a distant early warning signal of general artery narrowing.
Seeking Out the Truth
For many men in their middle years the gradually compromised circulation to their hearts leads to easy breathlessness and fatigue. It is usually dismissed lightly, as being "out of shape," with the unspoken but reassuring corollary that one could recover the lost fitness with a few push-ups. The truth lies elsewhere. A certain amount of health has been compromised and a certain amount of performance permanently lost. To the feeling of drained energy and need for caffeine to crank up as a sign of coronary artery disease, to the easy breathlessness on effort, we must now add another sign of artery narrowing: sexual failure. No, the heart attack isn't the neat, clean bolt from the blue it used to be.
For readers interested in a program to lower cholesterol a colorful reference chart is available. Send $5 to this paper, P.O. Box 1501, Ann Arbor, Mich. 48106. Ask for Coronary Care Unit No. 303 and make check to National Health Systems.