Over recent years, some studies have suggested that erectile dysfunction (ED) can be a potential warning sign for heart disease, though the evidence was fairly limited. But a new study may provide the strongest indication to date that the link does exist.

The study followed more than 1,900 men aged 60 to 78 over a period of four years. Findings were published in the American Heart Association's journal Circulation on June 11.

ED refers to the difficulty in achieving or maintaining a strong enough erection for any kind of sexual activity. To achieve an erection, there needs to be adequate blood supply to the penis among other factors like proper nerve functioning. The research acknowledged that cardiovascular disease and ED shared some common risk factors including obesity, hypertension, smoking, diabetes etc.

"Our results reveal that erectile dysfunction is, in and of itself, a potent predictor of cardiovascular risk," said senior investigator of the study Michael Blaha, an associate professor of medicine at the Johns Hopkins School of Medicine in Baltimore. Study participants who reported ED were twice as likely to experience heart attacks, cardiac arrests, sudden cardiac death, and strokes of both fatal and non-fatal nature.

According to the Mayo Clinic, many experts believe ED preceding heart disease may be due to problems with the inner lining of the blood vessels, affecting the flow of blood to the heart and the penis. The authors suggest that ED affects nearly 20 percent of men over the age of 20.

"Our findings suggest that clinicians should perform further targeted screening in men with erectile dysfunction, regardless of other cardiac risk factors and should consider managing any other risk factors — such as high blood pressure or cholesterol — that much more aggressively," Blaha added.

Participants of the study are a part of the ongoing Multi-Ethnic Study of Atherosclerosis, following more than 6,000 people across the United States who are of various ethnic and racial backgrounds.

During the four-year follow-up of the study, a total of 115 heart attacks, strokes, cardiac arrests, and sudden cardiac deaths were reported. 6.3 percent of men who had ED experienced the aforementioned health conditions and adverse events compared to only 2.6 percent of men who did not have ED.

After adjusting for other potential risk factors, it was found that men with ED were twice as likely to suffer cardiovascular events as men without ED.

Blaha stated that men who notice the onset of ED should seek comprehensive cardiovascular risk evaluation from a preventive cardiologist. "It is incredible how many men avoid the doctor and ignore early signs of cardiovascular disease, but present for the first time with a chief complaint of ED. This is a wonderful opportunity to identify otherwise undetected high-risk cases," he said.