Erectile dysfunction (ED) is a powerful, independent predictor of serious heart disease, according to a pair of recent studies.

“What is new is that ED remained a significant factor for developing heart disease after controlling for other risk factors for cardiovascular disease,” says Robert A. Kloner, MD, PhD, a professor of medicine at Keck School of Medicine at the University of Southern California and director of research for the Heart Institute at Good Samaritan Hospital in Los Angeles.

Both projects involved diabetics who complained of ED more than three years before the onset of coronary symptoms. The larger study involved 2,306 men who were undergoing comprehensive assessments for diabetic complications (J Am Coll Cardiol. 2008;51:2045-2050). About one quarter of them reported ED at baseline.

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Over four years of follow-up, 123 men (5.3%) suffered a heart attack, developed chest pain caused by clogged arteries, required bypass or catheter surgery, or died of coronary heart disease (CHD).

Men who had ED when the study began were 58% more likely to experience one of those cardiac events than men who did not. According to a statistical analysis, 19.7 of 1,000 diabetic men with ED could be expected to experience a CHD event each year, compared with only 9.5 of 1,000 diabetic men without ED.

“ED should alert providers to the future risk of CHD,” says lead author Peter Chun-Yip Tong, PhD, associate professor of medicine at The Chinese University of Hong Kong.

Meanwhile, Italian researchers investigated a group of 291 diabetic men whose “silent CHD” had been discovered during stress tests. At baseline, 118 of these men also had ED (J Am Coll Cardiol. 2008;51:2040-2044). The researchers then tracked what they called major adverse cardiac events (MACEs) (e.g., heart attack, sudden death, unstable angina, stroke, transient ischemic attacks, and peripheral arterial disease in the legs).

Forty-eight men experienced a major event during the next four years. Men who had ED at baseline were about twice as likely to experience a MACE as those who did not (61.2% vs. 36.4%).

“Our data showed that ED is a powerful predictor of cardiovascular morbidity and mortality in diabetic patients with silent CAD,” the researchers conclude.