If you have erection problems, get your cardiovascular health checked first; don't treat it as only a “private matter”

Moderate value
Evidence A
Buys life
Costs a little
Takes some hours
No willpower

In plain words

Men with erectile dysfunction later get cardiovascular disease about 40% more often than other men, and heart attacks about 60% more often. The younger the man, the bigger the gap. This problem often shows up before chest pain does. So get your blood pressure, blood sugar and blood lipids checked, and don't buy pills yourself to cover it up.

Cost: Registration costs a few dozen CNY. A blood pressure reading and blood tests for glucose and lipids cost one or two hundred CNY. One hospital trip, then a few days waiting for results.
What you get: A meta-analysis pooled 14 follow-up studies with 92,757 men in all, followed for 6.1 years on average. Compared with men without erectile dysfunction, men with the problem had the following later risks. Overall cardiovascular events were about 44% higher (RR 1.44; 95% CI 1.27 to 1.63, the plausible range). Heart attack was about 62% higher (RR 1.62, 1.34 to 1.96). Cerebrovascular events were about 39% higher (RR 1.39, 1.23 to 1.57). Death from any cause was about 25% higher (RR 1.25, 1.12 to 1.39). For cardiovascular death the gap did not open up (RR 1.19, 0.97 to 1.46). The younger the age, the higher the multiple. In men whose baseline cardiovascular risk was intermediate, the multiple was higher than in high-risk and low-risk men. In studies that used a questionnaire to define the problem, the multiple was 1.61 (1.38 to 1.86). In studies that asked a single question it was 1.27 (1.18 to 1.37).
Notes: All 14 studies followed a group of people to see outcomes; they were not randomized trials. So the “40% higher” is an association and can't be taken as cause and effect. One or two occasions don't count; treat it as a problem only if it lasts more than 3 months. What to check is the same set as in §1.7, §1.8: blood pressure and fasting blood glucose, plus blood lipids, smoking and waist size. Don't buy “male enhancement” supplements online. The legitimate drugs are prescription drugs; their labels list nitrates as a contraindication, and people taking nitroglycerin-type drugs must not take them, because together they can make blood pressure drop sharply. For how to improve, see §1.29 (losing weight and quitting smoking can improve erectile function). The benefit is rated “medium,” not “large”: the 44% is the gap in risk between two groups, not how much “getting checked once” lowers deaths. It is not rated “small” either: unlike the signal in §1.27 (visible blood in the urine), which has only a detection rate, the high blood pressure, diabetes and dyslipidemia found here all have established treatments.
Evidence grade: A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
Sources: Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI (2013). Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circulation: Cardiovascular Quality and Outcomes, 6(1), 99-109. https://doi.org/10.1161/CIRCOUTCOMES.112.966903
DailyMed（美国国立医学图书馆的药品说明书库）. VIAGRA (sildenafil citrate) tablet, CONTRAINDICATIONS. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d905dc8d-917f-4ea3-a4ee-a1ecf6967d4e

Mentioned in

Don't believe that “masturbation harms the body” or that you must “quit lust” (戒色) to get better; what to watch is whether it is costing you sleep, work and relationships

Translated from the Chinese original. Original book, section 1, tip 28. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer