By Bill Hendrick WebMD Health News
Reviewed by Laura J. Martin, MD

March 15, 2010 -- Erectile dysfunction is a major warning sign for
cardiovascular disease and early death.

The finding comes from placebo-controlled studies comparing randomly
selected men with ED and cardiovascular disease and men without ED.

The men with ED and cardiovascular disease were:
•1.9 times more likely to die from cardiovascular disease
•Twice as likely to have a heart attack
•1.2 times more likely to be hospitalized for heart failure•1.1 times
more likely to have a stroke
The researchers say they found that medications like ramipril, an
angiotensin-converting enzyme (ACE) inhibitor used to treat high blood
pressure and heart failure, can reduce cardiovascular events but don't
seem to influence the course or development of ED.

"Erectile dysfunction is something that regularly should be addressed
in the medical history of patients," Michael Bohm, MD, lead author of
the study and chairman of internal medicine at the University of
Saarland in Germany, says in a news release. "It might be a symptom of
early atherosclerosis."

The study included 1,549 male cardiovascular patients in 13 countries.
Each was asked if he had ED, and men who answered in the affirmative
were then categorized as having mild, mild-to-moderate, moderate, or
severe ED. The average follow-up was five years.

Patients in one trial involving 400 men were randomly assigned to take
ramipril, telmisartan -- an angiotensin II receptor antagonist used to
treat hypertension and heart failure -- or a combination.

In another, ACE inhibitor-intolerant patients were randomly assigned
to take a placebo or telmisartan.

Patients with ED were older and had a higher prevalence of
hypertension, stroke, diabetes, and lower urinary track surgery than
men without ED. And 55% of men had ED when they entered the trials.

Researchers say deaths from all causes occurred in 11.3% of patients
who had ED at the start, but in only 5.6% of people with no ED or only
mild problems at baseline.

They report that 16.2% of ED patients died from cardiovascular
problems, suffered heart attacks or strokes, or were hospitalized for
heart failure. Only 10.3% of men with no or mild ED had similar
outcomes.

As ED worsened, risk of death from all causes increased, suggesting
that ED identifies men whose cardiovascular disease might be
dangerously advanced.

Bohm says that ED is closely associated with conditions that occur in
atherosclerosis and vascular problems, such as plaque buildup, which
often precedes heart attacks and strokes.

"Men with ED going to a general practitioner or a urologist need to be
referred for a cardiology workup to determine existing cardiovascular
disease and proper treatment," Bohm says. "ED is an early predictor of
cardiovascular disease."

Men with ED are often treated for impotence but not underlying
cardiovascular disease, he says, thus placing "a whole segment of men"
at increased risk of death.

Therefore, men and their doctors need to view ED as a risk factor,
just as they do high blood pressure and cholesterol, he says