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 to cardiovascular disease or heart attacks as those who do not have the problem, German researchers reported Monday in Circulation: Journal of the American Heart Assn.

Researchers have known for years that there is a link between erectile dysfunction, commonly abbreviated as ED, and heart disease, said Dr. 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.”

The results are probably not too surprising, added Dr. Robert Kloner, a cardiologist at USC’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 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.

Existing 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.” Kloner, a coauthor of those guidelines, said that when the guidelines are updated this year, they will probably carry a stronger recommendation that a patient presenting with ED get a cardiovascular examination.

Dr. Michael Bohm, a cardiologist at Germany’s Saarland University, and his colleagues studied 1,519 men from 13 countries who were involved in a study of two drugs to treat cardiovascular disease. The men were also queried about their ED at the beginning of the study, two years into it and at the end at five years. A full 55% of the men had ED at the beginning of the trial, nearly double the normal incidence of about 30% in the population at large.

The team reported that, in the five years of follow-up, men with ED were 1.9 times as likely to die from heart disease, twice as likely to have a heart attack, 1.2 times as likely to be hospitalized for heart failure and 1.1 times more likely to have a stroke. The risks increased with the severity of the ED.

Disappointingly, the two drugs tested in the study, ramipril and telmisartan, did not improve the course of the ED.

That’s not surprising, said Dr. Peter Pelikan, a cardiologist at Saint John’s Health Center in Santa Monica, “because it takes years and years and years to get any resorption of cholesterol” that would reduce blockage of the penile arteries. “The study was too small and too short to see that.”

Many men with ED see a general practitioner or a urologist to get treatment and are prescribed drugs like Viagra or Cialis, Bohm said in a statement. “The drug works and the patient doesn’t show up any more. These men are being treated for ED, but not the underlying cardiovascular disease. A whole segment of men is being placed at risk.”

thomas.maugh@

latimes.com