Heart health and erectile function share several important connections. Understanding these connections may help you recognize the symptoms of cardiovascular disease sooner — and improve your chances of maintaining your sexual ability.

• Atherosclerosis. This damaging process, which reduces blood flow to your heart and contributes to coronary artery disease, could also affect the blood vessels to the penis, keeping you from sustaining an erection. Conversely, if you're having trouble with erections, it could be a sign that your heart is also at risk.
• Medications. Some prescriptions that men take to protect their hearts can cause erectile dysfunction. Additionally, medications that are often prescribed for erectile dysfunction may not be safe when combined with certain heart medications.
• Anxiety and depression. Erectile dysfunction itself can be a significant source of anxiety for men. Add to that a fear that sexual activity could cause a heart attack, and your love life could take a plunge. Depression frequently affects men with heart disease. Both the condition itself and some of the medications used to treat it can lead to erectile dysfunction.

If atherosclerosis has made your coronary arteries narrow and stiff, that means arteries elsewhere in your body are probably also affected. Atherosclerosis can prevent enough blood flow from reaching your heart, legs, brain and penis. When atherosclerosis affects blood flow to your penis, the blood can't sufficiently fill the penis to allow a suitable erection.

In one study, 64 percent of men who'd had heart attacks had erectile dysfunction before they knew they had cardiovascular disease. Some experts suggest that if you haven't been diagnosed with heart problems, consider erectile dysfunction a wake up call. It could be a warning sign that the blood vessels feeding your heart might also be in trouble.

The same factors that raise your risk of atherosclerosis in the arteries in your penis also increase your chances of coronary artery disease. Because the arteries supplying your penis are smaller than the ones to your heart, symptoms may first show up as erectile dysfunction.

Risk factors for cardiovascular disease and can contribute to erectile dysfunction include:

• Diabetes. Men who have diabetes have more problems getting an erection than do men who don't have diabetes. The problem is partially due to the diabetes-related damage to blood vessels that supply the penis.
• Obesity. Overweight men are more likely to have erectile dysfunction.
• High cholesterol. A high level of low-density lipoprotein (LDL, or "bad") cholesterol contributes to atherosclerosis in blood vessels, raising the risk of erectile dysfunction.
• Smoking. Smoking cigarettes raises your risk of developing atherosclerosis. Not only does smoking increase your chances of heart disease, but it can make you nearly twice as likely to develop erectile dysfunction.
• High blood pressure. Over time, high blood pressure damages the lining of your arteries and accelerates the process of atherosclerosis — which can lead to cardiovascular disease and erectile dysfunction.

Some medications that treat cardiovascular disease can make you more likely to develop erectile dysfunction. These include:

• High blood pressure medications such as clonidine (Catapres), and beta blockers such as metoprolol (Lopressor)
• Diuretics such as spironolactone (Aldactone), used for high blood pressure as well as heart failure

Doctors don't know exactly why some medications can contribute to erectile dysfunction. However, when your blood pressure is lower, your body might not be able to get enough blood through arteries in your penis that are affected by atherosclerosis. Also, some of these drugs, including beta blockers, have been found to lower your levels of testosterone, a hormone that affects your interest in sexual activity.

Although you can't stop taking your medications, there may be other drug options that are less likely to cause erectile dysfunction. Discuss your symptoms and potential options with your doctor.

Medications prescribed for treatment of erectile dysfunction may cause significant side effects when mixed with certain heart drugs called nitrates.

Nitrates are often prescribed to reduce chest pain, dilate the blood vessels and lower blood pressure. Because erectile dysfunction medications, such as sildenafil (Viagra), also reduce blood pressure, combining these two types of medication can cause a dangerous drop in blood pressure.

Do not take sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) if you use nitrates, such as nitroglycerin, for chest pain.

If you have coronary artery disease or have had a heart attack in recent months, be sure to check with your doctor before you begin taking any of these drugs for erectile dysfunction.

Men who've had a heart attack or surgery to treat their heart disease are often anxious about resuming an active sex life. However, intercourse seldom causes heart attacks. Sexual activity with your usual partner in a familiar setting doesn't lead to a particularly high blood pressure level or heart rate. Even if you're at high risk of having a heart attack, weekly sexual activity only slightly raises the risk.

Talk to your doctor about when you can resume sexual activity after you've had heart problems or surgery. To further reduce your risk of heart attack, avoid heavy meals and alcohol before sex.

Depression affects many men who have cardiovascular disease. Although there is mounting evidence that depressive symptoms are associated with an increased cardiovascular event risk, it remains uncertain whether the depression symptoms are playing a role causing heart disease, or whether they occur as a result of a chronic health condition.

Depression is often treated with selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and others. Erectile dysfunction may occur as a side effect of these drugs.

If you take medication for depression and have sexual side effects, you may be able to switch to a different SSRI or a different type of medication for depression. Your doctor can also decrease the dose or add another medication to offset the effects of the SSRI on erectile dysfunction.

Though developing erectile dysfunction is distressing, the condition may have a silver lining. It could tip off you and your doctor to possible cardiovascular disease. Talking to your doctor about any other cardiovascular risk factors you have — including obesity, a sedentary lifestyle, diabetes, smoking, high blood pressure and elevated lipids — may help you prevent heart disease. Making simple lifestyle changes to treat these risk factors may also improve your ability to have an erection.