Middle-aged men who stay slim usually have a low risk of developing heart disease, but if they have erection difficulties that could be an early warning sign of trouble ahead.

In such men, erectile dysfunction is associated with metabolic syndrome, which is often a precursor of heart disease and diabetes, a new study shows.

The metabolic syndrome is a constellation of symptoms - including fat accumulation around the belly, poor regulation of insulin, abnormal blood fat levels and borderline high blood pressure - that represent an increased risk of heart disease and diabetes, the researchers explain in The Journal of Urology.

Dr. Varant Kupelian of the New England Research Institutes in Watertown, Massachusetts, and colleagues point out that finding a way to identify people at risk of developing metabolic syndrome could help prevent them progressing to full-blown diabetes and heart disease.

The team analyzed data on a group of 928 men who were initially free of metabolic syndrome who were followed for 15 years. Fifty-six of the men had erectile dysfunction at the study’s outset, while 293 developed the metabolic syndrome during the course of the study.

Overall, the researchers found, body weight affected the association between erectile dysfunction and the development of metabolic syndrome.

Among men with a body mass index greater than 25 - the upper limit of normal - there was no link between erectile dysfunction and risk of developing the metabolic syndrome. However, men with BMIs below 25 and erectile difficulties were about twice as likely to develop the syndrome.

“This finding suggests that erectile dysfunction may provide a warning sign and an opportunity for early intervention in men otherwise considered at lower risk for the metabolic syndrome and subsequent cardiovascular disease,” the researchers conclude.

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SOURCE: The Journal of Urology, July 2006