(Health.com) -- Middle-aged men who take steps to improve their heart health by eating better, getting more exercise, or taking cholesterol-lowering drugs may end up improving their sex lives as well, according to a new analysis of existing research. 

Nearly 1 in 5 men in the U.S. has difficulty achieving or maintaining an erection, a condition known as erectile dysfunction (ED). The new study, which appears this week in the Archives of Internal Medicine, suggests that ED drugs such as Viagra aren't the only solution and aren't always enough to address the problem, says coauthor Dr. Stephen Kopecky, M.D., a cardiologist at the Mayo Clinic in Rochester, Minnesota. 

"If you do take care of your lifestyle—eating right, exercising, losing weight—you respond much better to the Viagra, the Levitra, the Cialis," Kopecky says. By the same token, he adds, if these drugs become less effective "that should be a sign that...you need to take care of your lifestyle.'" 

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ED is troubling enough by itself, but to make matters worse it's also a known harbinger of heart disease. The arteries in the penis that expand during an erection can become weakened and clogged with cholesterol in the same way as the arteries that surround the heart. This is why ED often shows up three to five years ahead of life-threatening cardiovascular problems such as heart attack or stroke, especially in younger men, Kopecky says. 

"The common denominator is blood flow," he explains. "If you look at a guy in his 40s who has erectile dysfunction and then you compare [him] to another guy in his 40s who doesn't have erectile dysfunction, the guy with ED is about 50 times more likely to have heart disease." 
who is?
Dr. Stephen Kopecky, M.D., a cardiologist at the Mayo Clinic in Rochester, Minnesota. 
