Several population-based studies have described a link between erectile dysfunction (ED) and cardiovascular disease. In addition, ED has been found to precede serious cardiovascular disease with 3-5 years. The most likely pathofysiological mechanisms include atherosclerosis and endothelial dysfunction, which result in ED before they cause disease in the remaining cardiovascular system. The link between ED and subsequent cardiovascular disease permits physicians to perform opportunistic screening and initiate secondary prophylaxis with regard to cardiovascular risk factors in men with ED.