IErectile dysfunction is strongly linked with age, cardiovascular disease, and diabetes, but lifestyle changes such as increased physical activity may prevent all three conditions, according to an article in the February 1 issue of the American Journal of Medicine.

More than 18 million men in the United States over age 20 years are affected by erectile dysfunction, according to the study by researchers from the Johns Hopkins Bloomberg School of Public Health.

“Physicians should be aggressive in screening and managing middle-aged and older patients for erectile dysfunction, especially among patients with diabetes or hypertension,” said Elizabeth Selvin, PhD, MPH, lead author of the study and a faculty member in the Bloomberg School of Public Health’s Department of Epidemiology. “The associations of erectile dysfunction with diabetes and cardiovascular risk factors may serve as powerful motivators for men who need to make changes in their diet and lifestyle.”

For the study, the research team analyzed data from 2,126 men who participated in the National Health and Nutrition Examination Survey (NHANES). Men who reported being “sometimes able” or “never able” to get and keep an erection were categorized as having erectile dysfunction, while men who reported being “always or almost always able” or “usually able” were not so classified.

The overall prevalence of erectile dysfunction among men in the United States is roughly 18 percent. In the study, men aged 70 years and older were much more likely to report erectile dysfunction; it was reported by only 5 percent of men between the ages of 20 and 40 years.

Nearly half of all men in the study with diabetes also had erectile dysfunction. Also notable was the finding that almost 90 percent of all men with erectile dysfunction had at least one risk factor for cardiovascular disease, including diabetes, hypertension, elevated cholesterol levels, or being a current smoker. Men with erectile dysfunction were also less likely to have engaged in vigorous physical activity within the month prior to participation in the study.