Researchers say they now have even stronger evidence that erectile dysfunction is connected to heart attacks, strokes, and other cardiovascular risks.

If you see a doctor about erectile dysfunction, you should also ask them about your heart health.

That’s the takeaway from a new study that examined the already well-known ties between erectile dysfunction and cardiovascular risk — and found the link to be even stronger than previously known.

The study participants — 1,900 men between the ages of 60 and 78 — were twice as likely to have a heart attack or other cardiac event during the four-year study period if they reported suffering from erectile dysfunction.

That was after adjusting for the impacts of smoking, high blood pressure, and other traditional risk factors.

The findings led the researchers to declare erectile dysfunction (ED) itself a “potent predictor of cardiovascular risk.”

They also suggested that physicians should screen for such risks in patients that have erectile dysfunction, even if no other risk factors are present.

The study was published by the American Heart Association in its journal, Circulation.

The study builds on previous knowledge of ties between ED and diminished heart health.

One of the prime reasons for erectile dysfunction is cardiovascular trouble, which can lead to decreased blood flow to the penis and, consequently, decreased ability to get and maintain an erection.

Having ED has previously been tied to a hardening of the arteries that carry blood through the heart. That makes it more difficult for blood to flow easily through the arteries, potentially leading to blood clots, heart attacks, or strokes.

The new study looked at cardiac events, not just the ailments that can sometimes lead to them.

That furthers the “continuum” of what we know about ties between ED and heart health, said Dr. Richard Becker, chief of cardiology at the University of Cincinnati College of Medicine in Ohio.

Becker told Healthline what stood out to him is the “strength of the association between ED, and not hardening of the arteries — atherosclerosis — which is what the focus has been before; but here, we see a twofold increase in the likelihood of cardiovascular events. And they’re not subtle events — heart attacks, strokes, death.”

Becker, who wasn’t involved in the study but is a spokesperson for the American Heart Association, said 10 percent of men over the age of 20 have ED, “so physicians can really benefit from this type of information” about its ties to heart health.

The awareness of these ties has been increasing in recent years.

Last year, erectile dysfunction was recognized as a risk factor for heart disease in the United Kingdom. It hasn’t yet earned that recognition in the United States.

“It could be that the U.S. is a little behind the times in terms of updating its guidelines,” said Dr. Lawrence Jenkins, a urologist and men’s health expert at The Ohio State University’s Wexner Medical Center.

Jenkins, who also was not involved in the new study, said experts already know the onset of ED can precede cardiac events by two to five years.

The new findings, he said, add to the evidence that it should be treated as a risk factor, and gives more impetus for primary care providers to make sure ED patients are screened for heart risks.

Jenkins said he has “not seen much” in the way of cardiovascular workups, such as cholesterol checks or lipid panels, in patients with ED that are referred to him.

He hopes studies like this one will help raise awareness among primary care doctors. They’re the first doctor patients with ED typically see, and thus, the first line of defense against combating possible future cardiac events.

Jenkins said he knows a cardiologist who is aware of the ED association, but patients only see specialists like cardiologists when they’re referred to them.

“So, the need is to raise awareness among those primary care providers,” he said.

Becker also saw that as the biggest potential impact of the new study.

“I’m hoping this study will drive that (tie) a little bit harder and faster so that physicians will routinely be including ED when they’re screening patients for cardiovascular disease,” he said. “Doctors should ask the question and consider whether hardening of the arteries is occurring, ask about family history and signs or symptoms like chest pain with exertion, and spend the requisite amount of time to find out what’s going on.”

The next step in raising that awareness, he said, would be educating the public so patients will ask about risks rather than relying on doctors to bring them up.