Two recent studies suggest that erectile dysfunction (ED) should be considered a warning sign for cardiovascular events among men with diabetes. In one study, Chinese researchers studied 2,306 men with type 2 diabetes with no clinical evidence of cardiovascular disease (CVD). At the start of the study, 27% had ED. During the 4-year study, these men had a 1.6-fold increase in risk of experiencing coronary events compared with men without ED.

An Italian study reinforces this finding. Researchers studied 291 men with type 2 diabetes and angiographically documented silent coronary artery disease (CAD). In all, 118 men had ED at the start of the study. After almost 4 years of follow-up, 49 men had experienced major adverse cardiac events (MACE). Those who'd had ED at the start of the study were twice as likely to experience these events. In addition, among patients with CAD and ED, use of statins and 5-phosphodiesterase (5-PDE) inhibitors was associated with a lower MACE rate. Sildenafil citrate (Viagra), which is approved to treat ED and other disorders, is a 5-PDE inhibitor.

The Italian researchers concluded that ED is a "powerful predictor" of serious cardiovascular events in patients with diabetes and silent heart disease. They suggest that treatment with statins and 5-PDE inhibitors could reduce occurrence of MACE among diabetic patients with CAD and ED.

Sources: Ma, RC et al., Erectile dysfunction predicts coronary heart disease in type 2 diabetes, Journal of the American College of Cardiology, May 27, 2008; Gazzaruso C, et al., Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with angiographically proven asymptomatic coronary artery disease, Journal of the American College of Cardiology, May 27, 2008.