Heart disease represents the prime cause of mortality of people around the world. With the rising number of patients with heart problems threatening to overwhelm medical resources—the race towards more sensitive predictive factors continues to challenge researchers. Read on to learn more about how marriage, erectile dysfunction (ED) and genetics can influence the risk of cardiovascular diseases (CVDs).

1. Erectile dysfunction as a potential surrogate marker for cardiovascular disease

Erectile dysfunction was found to be strongly associated with vascular endothelial dysfunction.
Erectile dysfunction was found to be strongly associated with vascular endothelial dysfunction.

Men suffering from ED may in fact be at higher risk of developing cardiovascular diseases. Such was the conclusion drawn by a team of researchers from Baptist Health South Florida, Florida International University, and Mount Sinai Medical Centre in the United States1.

Erectile dysfunction was found to be strongly associated with vascular endothelial dysfunction. Vessel damage is a key disease process that underlies strokes and heart attacks. Interestingly, the analysis found that ED may prove to be useful in detecting subclinical CVD1.

Two commonly used parameters in detecting subclinical CVD are the coronary artery calcium score and the thickness of the carotid intima-media. Of these, the latter was worse in those with ED. A thicker carotid lining is a proven indicator of the presence of atherosclerosis2.

The authors believe that these findings will be a valuable indicator of potential cardiovascular disease in young men. “Measures of erectile dysfunction could be a simple, effective cardiovascular disease risk stratification tool, particularly in young men who are less likely to undergo aggressive cardiovascular disease risk assessment and management,” wrote the authors2.

2. Can getting married save a person from heart issues?

In a large study looking at 6,051 patients with coronary artery disease, being currently married appeared to be protective against heart disease3.

Compared to those who were currently married, there was a 40% increase in risk of dying from CVD in those who were never married; and a 41% increase in those who were separated or divorced. Those who were widowed suffered a 70% higher risk of dying from CVD, compared to their married counterparts3.

"I was somewhat surprised by the magnitude of the influence of being married has," commented Dr Arshed Quyyumi, lead researcher of the study. "Social support provided by marriage, and perhaps many other benefits of companionship, is important for people with heart disease," he added3.

Surprisingly, unmarried individuals were also found to be 24% more likely to die from any cause. This highlights the importance of taking into consideration social circumstances, as it may warrant more aggressive intervention3.

"I wouldn't say that if you have heard disease, you have to get married... But I think doctors, family and friends can pay more attention when life events occur – perhaps these people need extra care and attention to compensate for things they now are missing," highlighted Dr Quyyumi4.

However, researchers urge caution in interpreting study findings and do not recommend applying it to the general population without CVD. (The current study was only done in a single institution and did not consider those who cohabited3.)

3. Genetic makeup found to dictate responses to common cardiovascular drugs

Personalised medicine looks set to play an even more intimate role in the lives of patients with heart disease. A Malaysian based pharmacogenetics group (Malaysian Genomics and Clinipath) has recently observed that specific genetic mutations were able to influence patients' responses to common cardiovascular drugs5.

It was discovered that 42% of individuals tested were found to have mutations that made them less sensitive to the effects of antiplatelet clopidogrel. Furthermore, 13% of patients were discovered to carry genes that made them more susceptible to developing adverse reactions to popular anti-cholesterol agent simvastatin. In comparison to existing literature, 20% and 2% of Caucasians respectively displayed the gene mutations concerned5.

It is important for studies to be done on different populations, as ethnicity plays a big role in genetic makeup.
It is important for studies to be done on different populations, as ethnicity plays a big role in genetic makeup.

Variability between individual responses to medication has always been an educated guessing game. The field of pharmacogenetics has strengthened the role of evidence guided medicine and leaves less to chance. It is well known that genes influence different components of the drug response pathway.

Strong evidence exists for drugs such as warfarin, diuretics, beta-blockers and angiotensin-converting-enzyme inhibitors6. It is important for studies to be done on different populations, as ethnicity plays a big role in genetic makeup – evidenced by the Malaysian study.

The commercial availability of genetic profiling tests could greatly optimize medication prescription and lead to overall better health outcomes. Currently four different genetic test panels covering mental health, pain and immunology, gastroenterology and urology as well as cardiovascular and diabetes are available in Malaysia5. MIMS

Read more:
Hypochondria: How worrying over health increases risk of heart disease
Younger Malaysians getting heart disease as country tackles obesity epidemic
Personalised medicine: Tailored to fit each person’s genes

Sources:
1. http://www.freemalaysiatoday.com/category/leisure/2017/12/19/erectile-dysfunction-could-help-reveal-cardiovascular-disease-risk/
2. http://www.cardiovascularbusiness.com/topics/vascular-endovascular/erectile-dysfunction-proves-early-predictor-subclinical-cvd
3. http://www.freemalaysiatoday.com/category/leisure/2017/12/22/marital-status-could-affect-heart-patients-risk-of-death/
4. http://abcnews.go.com/Health/married-heart-disease-patients-live-longer-study/story?id=51904761
5. http://mrem.bernama.com/viewsm.php?idm=30837
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781215/