Erectile dysfunction as an early warning sign for heart attack and stroke

Erections change years before heart attack or stroke occur.
Reduced erectile function can be an early warning sign for systemic atherosclerosis and cardiovascular risks such as coronary artery disease, heart attack, or stroke. At this stage, intervention and course correction are still possible. Lifestyle changes can reverse atherosclerosis and prevent heart attack or stroke.

Erectile function as a vital sign in functional medicine

In functional medicine, erectile function is seen as a vital sign. Like heart rate, blood pressure, respiratory rate, and temperature, it reflects core physiological processes that keep the body alive and adaptive.
When erectile function changes, the body often signals that these systems are no longer working optimally.

Erectile changes often appear years before heart attack or stroke occur. What may begin as reduced rigidity, fewer spontaneous erections, or the absence of morning wood can later progress to atherosclerosis, coronary artery disease, heart attack, or stroke.

Erections change long before heart attack or stroke hit

Erectile dysfunction often precedes the diagnosis of coronary artery disease by several years (Montorsi et al. 2003, p. 263). The arteries supplying the penis are small. Because of their size, reduced blood flow affects them earlier than larger arteries supplying the heart or brain.

The same process underlies both conditions: atherosclerosis. Fatty deposits, inflammation, and reduced vessel flexibility restrict blood flow. In the penis, this shows up early as erectile changes. In the heart or brain, it may later result in heart attack or stroke.

Why morning wood matters

Spontaneous erections are a healthy bodily response. In people with a penis, they occur several times per night during sleep and often during states of physical or mental relaxation. They depend on blood flow, intact nerve signalling, hormonal balance, and the ability of blood vessels to widen and relax.

Morning wood reflects how well these systems work together.
It requires:

flexible, responsive blood vessels
healthy endothelial function
intact nerve signalling between brain, spinal cord, and genital tissue
sufficient nitric oxide availability

When morning erections become less frequent or disappear, this often points to early vascular changes. That is why erections tend to change long before heart attack or stroke occur.

Atherosclerosis can be reversed if detected early

Atherosclerosis does not appear overnight. It develops gradually and can be influenced early on.

Nutrition and lifestyle changes can reverse atherosclerosis when addressed early. They can improve endothelial function, reduce inflammation, stabilise plaque formation, and restore blood vessel flexibility (Ross 1999, p. 115; Libby et al. 2011, p. 1137).

This matters because untreated atherosclerosis can later lead to coronary artery disease, heart attack, or stroke. Early action can change that trajectory.

Nutrients and lifestyle can support healthy erections, reverse atherosclerosis and prevent heart attack and stroke

Nutrition, metabolic health, body fat distribution, movement, sleep, and stress all shape blood vessel function.

Omega-3 intake supports endothelial health, reduces chronic inflammation, improves lipid profiles, and supports blood vessel flexibility (Harris et al. 2009, p. 39; Mozaffarian and Wu 2011, p. 204). These effects directly support blood flow and vascular responsiveness.

Excess body fat, especially visceral fat, promotes inflammation, insulin resistance, and impaired nitric oxide signalling. These processes accelerate atherosclerosis and restrict blood flow long before symptoms such as heart attack or stroke occur.

Erectile changes often reflect these processes early.

Stress, nerve signalling, and erectile function

Erectile function depends on coordination between blood vessels and the nervous system.

Chronic stress, constant alertness, and mental pressure can disrupt nerve signalling involved in erection. This can reduce spontaneous erections even when blood vessels are still structurally intact.

Erectile changes can have different causes. Sometimes vascular factors dominate. Sometimes performance pressure or stress play a central role. Sometimes both interact.

Erectile changes deserve medical attention

If you observe persistent erectile changes, please have a medical check-up and ask for an assessment of atherosclerosis and cardiovascular risk factors.

You might hear “everything is fine”. Often that translates into “you are not severely ill”. It does not mean you are perfectly healthy or preventing heart attack or stroke down the road.

A holistic approach to erectile health

I work with erectile function from a holistic perspective. I combine somatic and nervous system based work with checking core nutrients and recommending lifestyle adjustments and supplementation as indicated.

You can explore this on two levels, together or separately:

Book an individual session to work with stress patterns, nervous system regulation, and embodied sexual response.
Book a free consultation for nutrient testing (such as Omega-3 status and fatty acid profile) and targeted supplementation to support vascular health and reduce cardiovascular risk.

References

Burnett, A.L. and Musicki, B. (2005). The nitric oxide signaling pathway in erectile dysfunction. Journal of Andrology, 26(6), pp. 720 to 728.

Gandaglia, G. et al. (2014). Erectile dysfunction and coronary artery disease: A systematic review and meta analysis. European Urology, 65(5), pp. 968 to 978.

Montorsi, P. et al. (2003). The artery size hypothesis. American Journal of Cardiology, 92(9), pp. 47M to 50M.

Mozaffarian, D. and Wu, J.H.Y. (2011). Omega 3 fatty acids and cardiovascular disease. Journal of the American College of Cardiology, 58(20), pp. 2047 to 2067.

Tousoulis, D. et al. (2014). Nitric oxide, endothelial function, and cardiovascular disease. Current Vascular Pharmacology, 12(3), pp. 437 to 449.