Erectile dysfunction (ED) is defined as the persistent or recurrent inability to achieve or sustain a penile erection, whose prevalence and severity increase in the older age. It is correlated with the use of several cardiovascular drugs or it can be associated with coronary heart disease. ED prevalence is estimated to be about 50% in patients with coronary heart disease whereas it can be an independent risk factor for future events in patients without cardiovascular disease. Diagnostic work-up in ED includes a cardiovascular screening, although the real benefit of that recommendation is at present unclear. Although patients affected by ED cannot be considered tout court at high cardiovascular risk, a more thorough evaluation may help identifying a high-risk subgroup needing a different therapeutic approach.