Not only that erectile dysfunction is something often met in men with type 2 diabetes, but also the presence of sexual problems in their case may be a significant warning for serious coronary heart disease, two new study reveal.

While the connection between heart disease and sexual problems has long been known, the new studies suggest that the development of erectile dysfunction may precede a heart attack by two to three years, said Robert Kloner a cardiologist at Keck School of Medicine in Los Angeles, California, who wrote an accompanying editorial on the studies.

Like coronary disease, erectile disease is a vascular disease. Heart disease appears when blood flow to the cardiac muscle is choked off usually because of fatty-plaque build up or clots in the arteries. Erectile dysfunction appears when blood vessels are damaged, this hindering the surge of blood needed to sustain an erection. Both heart disease and erectile dysfunction are prevalent among men suffering from diabetes, which can damage blood vessels throughout the body.

The first study by Chinese researchers tracked a group of 2,306 men with no evidence of heart disease for four years, including 26.7 percent with erectile dysfunction. At the end of the follow-up period, 123 men suffered heart attack, died from heart disease, developed chest pain linked to clogged arteries or needed heart surgery. Men with erectile dysfunction had a 58 percent higher risk of developing heart disease compared with men with normal sexual performance.

“The development of erectile dysfunction should alert both patients and healthcare providers to the future risk of coronary heart disease,” lead author Dr. Peter Chun-Yip Tong of the Chinese University of Hong Kong said, as quoted by BBC News.

The second study led by Dr. Carmine Gazzaruso, a specialist at the Beato Matteo Hospital Group in Vigevano, Italy involved 291 men in their mid-50s with a history of symptom-free coronary heart disease. Of 118 men with erectile dysfunction, 30 men or 25 percent suffered a serious cardiac problem over seven years. Only 19 of the 173 men without erectile dysfunction or about 11 percent suffered cardiac problems.

Gazzaruso’s study also looked at whether cholesterol-lowering medications are effective and found that they cut the risk of heart problems by about a third. However, the study raised the question of whether drugs used to treat erectile dysfunction, such as Pfizer’s Viagra, Eli Lilly & Co.’s Cialis and Bayer AG’s Levitra could be just useful for rescuing hearts, as they are for erections.

The conclusion of the two studies is very simple, experts say. Men having difficulty achieving or maintaining erections should tell their doctors immediately even if it’s embarrassing, so they can be evaluated for further cardiac risk. However, “a lot of men still don’t feel comfortable talking to their doctor about it,” according to Kloner. This is significantly important, because once doctors know about their patients’ sexual problems, they could prescribe more aggressive treatments for high blood pressure and cholesterol, two clear signs of coronary heart disease.

Additionally, men with erectile dysfunction, especially those suffering from diabetes, need to have a healthy diet, exercise regularly, and avoid smoking. According to a 2004 study, men who started exercise in midlife had a 70 percent reduced risk of erectile dysfunction compared to men who remained sedentary.

The two studies come at a time when type 2 diabetes is becoming an epidemic in the U.S. According to the Centers for Disease Control and Prevention, about 21 million Americans have diabetes and another 54 million have pre-diabetes, a condition involving higher-than-normal blood sugar levels that often leads to diabetes. The prevalence of the disease goes up dramatically after age 40. Between 35 and 50 percent of men with diabetes experience erectile dysfunction.

The findings will be published in the May 27 issue of the Journal of the American College of Cardiology.