Cardiovascular diseases (CVDs) are a significant source of morbidity and mortality despite improvements in treatment. The recognition of CV risk and the early identification of CVD are crucial to facilitate early intervention and preventative strategies. This chapter presents a critical review of the literature on the role of erectile dysfunction (ED) as an early marker for CVD risk. ED and CVD share a number of risk factors, while ED itself may be considered an important risk factor for CVD, particularly in younger men with arteriogenic ED. Epidemiological data support an association between ED and CVD, with reports suggesting that ED often occurs years prior to the onset of CVD. This reflects the shared pathophysiological mechanisms of ED and CVD and the earlier emergence of symptoms in small-diameter arteries, such as those in penile tissue, secondary to atherosclerosis and endothelial dysfunction. The importance of these observations is considered with respect to the clinical implications of studies exploring the predictive value of ED for future CVD risk. The chapter concludes with clinical insights into the role of ED in CVD risk assessment and the integration of ED assessment in routine CVD health screenings.