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Impotence (also called erectile dysfunction or ED) is the inability to get or keep an erection and may indicate increased risk for a heart attack. The association was uncovered in the course of a 19-year Mayo Clinic study involving approximately 2,000 men between the ages of 40 and 79 in Olmstead County, Minn. Results were reported on Nov. 11, 2003, at the annual conference of the American Heart Association.

So far, researchers don't know how ED is related to heart attacks, but they did discover that men were 3 to 5 times more likely to report erectile dysfunction in 1996, the first time the investigators asked questions about sexual dysfunction, if they had survived heart attacks. (All of the heart attacks occurred between 1979 and 1995.)

Approximately five percent of 40-year-old men and between 15 to 25 percent of 65-year-old men experience ED. Although the incidence of ED increases with age, it is not an inevitable part of aging. The most common physical causes are reduced blood flow and nerve damage, which can result from diabetes, kidney disease, chronic alcoholism, tobacco addiction, multiple sclerosis, atherosclerosis, vascular disease and neurological disease. Between 35 and 50 percent of men with diabetes also experience ED, and diabetes increases the risk of heart disease.

Based on the findings of the Mayo Clinic study, researchers concluded that erectile dysfunction did not have a true cause-effect relationship with heart attacks but was certainly a "marker" for them. In other words, ED should alert both patients and the doctors treating them to be on the lookout for cardiovascular risk factors or symptoms such as chest pain. Likewise, doctors may gain more insight into heart patients' risks by asking about sexual function.

Andrew Weil, M.D.