The relation between erectile dysfunction (ED) and cardiovascular disease (CVD) is relevant and important to all fields of medicine. ED is often not considered in the same context as traditional cardiovascular conditions, such as hypertension, dyslipidemia, ischemic heart disease, diabetes mellitus, or the insulin resistance/metabolic syndrome complex. Specific guidelines for treating men with ED and known CVD have been established and recently updated. This article focuses on ED as an early symptom of systemic CVD as well as insulin resistance and the metabolic syndrome. The diagnosis of ED and the subsequent evaluation of underlying cardiovascular risk factors could become a powerful clinical tool to help with early detection of atherosclerotic disease and enhance overall preventive vascular health in men.