Los Angeles » For the first time, researchers have shown that erectile dysfunction is a strong predictor of the likelihood that men will die of heart disease.

Men who suffer from the problem, which some consider more an emotional than a physical issue, are twice as likely to succumb from cardiovascular disease or heart attacks as those who do not have the problem, German researchers reported Monday in Circulation: Journal of the American Heart Association.

Researchers have known for years that there is a link between erectile dysfunction, commonly abbreviated as ED, and heart disease, said Sahil Parikh, an interventional cardiologist from University Hospitals Case Medical Center in Cleveland, who was not involved in the study. "But now there is pretty clear evidence that there is a substantially increased risk of heart attack and death when patients have erectile dysfunction," he said.

The results are probably not too surprising, added Robert Kloner, a cardiologist at the University of Southern California's Keck School of Medicine, "because arteries in the penis are smaller, so atherosclerosis shows up there sooner," perhaps three to four years before the onset of cardiovascular disease.

The take-home message, both experts said, is that when a patient seeks treatment for ED, typically from a general practitioner, he should be given a full physical work-up to look for heart disease and should be referred to a cardiologist. "When they are treated aggressively early, we can prevent heart attacks and stroke and they can have many years added to their lives," Parikh said.

Guidelines for treating men with ED from the Princeton Consensus Conference already state that "a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise."