(CNN) Men suffering from erectile dysfunction may be facing an even bigger problem than frustration in the bedroom. ED may well predict your risk for a future stroke or heart attack.

That's the takeaway from a meta-analysis of studies on more than 150,000 men published in the Journal of Sexual Medicine. Compared to men without symptoms of impotence, the analysis found men with ED have a 59% higher risk of coronary heart disease or atherosclerosis, a 34% higher risk of stroke and a 33% higher risk of dying from any cause.

"Erectile dysfunction can develop actually years before men have other signs or symptoms of cardiovascular events," said Dr. Ron Blankstein, a preventive cardiologist at Brigham and Women's Hospital and a member of the American College of Cardiology's Prevention Section and Leadership Council.

What is ED?

Erectile dysfunction is defined as the inability to create or maintain an erection that is firm enough for sex. There are many things besides cardiovascular disease that can interfere with a man's performance: stress, anxiety, sleep disorders, smoking, alcohol consumption and certain medications such as beta-blockers, blood pressure meds, antidepressants and antihistamines, to name a few.

Nor is a performance problem now and again considered a sign of impotence, said Blankstein, who is also an associate professor at Harvard Medical School. But if a man feels that his sexual performance is significantly worse than it has been in years past, then it's time to be concerned.

"In many cases, it might be the first warning sign of underlying cardiovascular disease," Blankstein added. "So, if erectile dysfunction is a repeated pattern, a man really needs to pay aggressive attention to potentially having heart disease."

'Canary in the coal mine'

There's a good reason why this particular male organ is a good predictor of future circulatory problems. It serves as a sort of "canary in the coal mine."

"The penile artery that delivers the blood flow to the penis is a much smaller diameter, and it's the smaller blood vessels which show the first signs of disease," Blankstein said. "They are unable to dilate and deliver sufficient blood flow."

To see if early heart disease may be a factor in your ED, Bankstein suggests a full workup at the doctor. Things to look for include abnormal blood sugars that might be a sign of diabetes, high cholesterol and blood pressure, and may even include a coronary artery calcium scan, to look for a plaque in the arteries of the heart.

What to do?

If you have ED, you may want to talk to your doctor about lifestyle interventions. As a preventative cardiologist, Blankstein would first make sure you don't smoke, or if you do, encourage you to quit.

"Smoking is the single most important modifiable risk factor, both for heart disease and for erectile dysfunction," he said.

Next on the list is weight loss and exercise, both important factors in improving erectile dysfunction and improving long term cardiovascular health. Try a plant-based diet, such as the Mediterranean diet, Blankstein suggests, which studies have shown to be of particular help.

"I think the important message is at the very least, you need to pay attention to your underlying risk factors for heart disease, smoking, diabetes and high cholesterol," Blankstein said. "And if you have erectile dysfunction to make sure that you're treating those even more aggressively."