What Causes Erectile Dysfunction? It Could Be Heart Disease

October 15, 2025

Erectile dysfunction (ED) can have many causes, both physical and psychological, but it’s often an early sign of cardiovascular disease.

“It can be a canary in the coal mine for more significant cardiovascular disease like heart attacks and strokes,” says University Hospitals urologist Aram Loeb, MD. “It may be a warning sign to take better care of yourself to reduce your risk.”

Fortunately, many treatment options exist. Dr. Loeb shares more.

A Common Condition

ED is a common condition that typically affects men over 40, but it’s becoming more frequent among younger men too. Occasional difficulty maintaining an erection is nothing to worry about – but if it happens often, it’s a good idea to speak with a healthcare provider.

Dr. Loeb says ED often is linked to cardiovascular disease because both are vascular problems. It’s believed that dysfunction of the inner lining of blood vessels impairs blood flow to the heart and the penis.

“A lot of things can cause erectile dysfunction, but ultimately, it’s a vascular process,” Dr. Loeb says. “It’s about getting blood flow into the penis. Allowing those vessels to expand and trap that blood in there is what is required.”

Men with ED should be assessed for cardiovascular risk factors.

ED and Heart Disease

ED and cardiovascular disease share many of the same risk factors:

Other possible causes of ED include: prostate problems, neurological issues, drug use, chronic sleep disturbance, kidney disease, and psychological conditions such as depression, stress and anxiety.

Many prescription medications can contribute to ED, including antidepressants, blood pressure medications and cancer drugs.

Emotional Factors & Stress

ED can cause significant emotional distress for both men and their partners. If left untreated, it may harm self-esteem and contribute to anxiety or depression. Emotional stress can trigger ED — and, in turn, ED can create additional stress and emotional challenges.

“I tell patients there’s always a psychological component,” Dr. Loeb say. “Once you start having trouble, it’s hard to get a good erection when you’re thinking about it. This can create a negative spiral where you start worrying and increasing physical symptoms.”

Fortunately, men tend to be more open about ED than in the past, probably because of the attention it has received in ED drug advertising, he says. “Men will come in and say, you know, this is really affecting my relationship. My wife doesn’t think I’m into her anymore and that’s not it at all,” Dr. Loeb says. “ED does cause stress outside the bedroom.”

Diagnosing and Treating ED

ED medications are typically an effective treatment. But they’re not for every patient. “Given the degree of erectile dysfunction, it may or may not work for you. But for the vast majority of guys, they do work,” Dr. Loeb says.

Sometimes changes in medications are needed, and some patients don’t tolerate the drugs well. “They cause vasodilation, which gets blood flow of the penis, but also gets blood rushing to your head. Some guys get a headache or kind of nasal congestion. Some guys get heartburn.”

Your doctor will take a medical history and may use ultrasound to evaluate blood flow in the penis. Blood or urine tests may also be done to determine the cause of ED.

Other treatment options include injections of medication into the penis and penile implant surgery. Patients can also be referred to counseling. Those with risk factors for cardiovascular disease are urged to make healthy lifestyle changes.

“Doing things to improve your overall health, such as exercise, eating well and losing weight, it’s all going to improve blood flow in the penis. It’s also going to improve blood flow throughout the body, so it’s recommended for everyone,” Dr. Loeb says.