Concerns around erectile dysfunction typically focus on a man’s inability to have sex. As serious a problem as this is, studies point to a more devastating issue that could be behind having difficulty maintaining an erection: heart disease.

Research has connected erectile dysfunction with heart disease in men between the ages of 30 to 60 for years, but it is still not commonly known among the public. “You hear about men who pass away from heart disease,” began Dr. Kevin Billups, director of Johns Hopkins Hospital’s Integrative Men’s Health Program, “and their wives find Viagra [in their belongings] and they didn’t even know they had a problem.”

For many men, experiencing erectile dysfunction is the first signal of risk factors which, if unchecked, can lead to heart disease, according to doctors. “The likelihood of having heart disease at some point is two to three times higher in those who have ED than those who don’t,” said Dr. Mehdi Shishehbor, a cardiology specialist at Cleveland Clinic.

But why would a problem affecting your penis signal a larger problem with your heart? “The penile arteries are much smaller than the arteries that supply blood to the heart, brain or lower extremities, and will block faster,” explained Dr. Billups. “Erectile dysfunction will often appear as a symptom years before the heart attack. The other reason is that the penis is more sensitive [than other organs] to early changes associated with increased risk of heart disease, such as inflammation and oxidative stress.”

Coronary heart disease occurs when the arteries around the heart harden and narrow, making it more difficult for much-needed blood to reach the heart muscles. A number of variables (high cholesterol, hypertension, smoking and/or diabetes, for example) cause this hardening, which can lead to chest pain or even a heart attack.

“The same process can happen in the pelvis,” Dr. Shishehbor explained. “The same risk factors that apply to coronary artery disease are the same risk factors that apply to blockages in the penis. Over the years blockages form and prevent blood from getting to the penis. In order to get an erection we need blood flow to the penis.

“As you age and if you don’t take care of your risk factors — if you smoke, don’t eat healthy, don’t control your blood pressure,” he continued, “those things can lead to the same process that leads to blockages in the heart and can cause blockages in the penis.”

If a man notices he has issues maintaining an erection, he should go to his primary care physician to get checked out, both doctors said.

“A lot of times I’ll pick up that their waist circumference is wider than 40 inches, and that they have high blood pressure or chloesterol problems,” all risk factors for heart disease, said Dr. Billups. “ED is the symptom that gets the guys’ attention.”

“Your cholesterol should be treated aggressively,” added Dr. Shishehbor. “Your diabetes, if you have it, should be controlled. You decide to stop smoking — obviously you should pick up a healthy lifestyle, improving your exercise and your eating habits.”

Once the risk factors are addressed, ED can then be treated in the ways most of us are familiar with: pills, vacuum pumps, injections and the like.

Getting the problem addressed as soon as you notice that you’re having a problem maintaining an erection is key to avoiding a potentially tragic — and potentially avoidable — end.

“Don’t get a pill from your buddy,” Billups said. “Go and get checked out. Fixing it is easy… if we can save your life.”