German researchers have said impotence is a strong predictor of heart attack and death among high-risk patients. <br/><br/>The study of 1,519 men from 13 countries who already had cardiovascular disease found those who were also impotent had twice the risk of a heart attack or death as the rest. <br/><br/>As well as being twice as likely to die or have a heart attack, those with impotence were also 10 per cent more likely to have a stroke and 20 per cent more likely to be hospitalised for heart failure, after adjusting for factors like age and smoking.<br/><br/>The University of Saarland report, published in the journal Circulation, suggests men with impotence should be checked for cardiovascular disease. <br/><br/>Impotence is linked to inadequate blood flow in the penile arteries. These are much smaller than coronary arteries.<br/><br/>So, for some men, a persistent failure to get an erection might be an early sign that his arteries are narrowing.