LOS ANGELES -- For the first time, researchers have shown that erectile dysfunction is a strong predictor of the likelihood of death by heart disease.

Men who suffer from the problem, which some consider more emotional than physical, 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 long known of a tie between erectile dysfunction, abbreviated as ED, and heart disease, said interventional cardiologist Sahil Parikh of Cleveland's University Hospitals Case Medical Center, who wasn't part of the study. "Now, there is pretty clear evidence that there is a substantially increased risk of heart attack and death when patients have erectile dysfunction."

The results are probably not too surprising, said cardiologist Robert Kloner of 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 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 sent to a cardiologist.

Guidelines for treating men with ED in the Princeton Consensus Conference already state that "a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proven otherwise." Dr. Kloner, a guidelines co-author, said that when they are updated this year, they will probably carry a stronger recommendation that patients with ED get a cardiovascular exam.

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