It's common for men over 60 to have difficulty maintaining erections. Two studies, one from Italy and one from the US, show that men who are impotent before that age are at significantly increased risk for heart attacks (JAMA, December 21, 2005; Journal of the American College of Cardiology, October 18, 2005.)

The most common causes of impotence are arteriosclerosis and diabetes. Less common causes include low levels of the male hormone, testosterone, or a brain tumor. So every man who is impotent before age 60 should check with his doctor and get blood tests for arteriosclerosis and diabetes. The tests should include cholesterol, homocysteine, Lipoprotein A, C-reactive protein and HBA1C. They also should get blood tests for testosterone and prolactin, the test for a brain tumor.

Since most impotent men will have arteriosclerosis or diabetes, they may need to take appropriate medications, but they certainly should be exercising and follow a heart-attack preventing diet. The diet I recommend restricts saturated fats, partially hydrogenated fats and refined carbohydrates; and includes a wide variety of fruits, vegetables, whole grains, beans, nuts and other seeds.

Don't just take Viagra; make sure you understand the cause of your impotence and heed its warning signals.