Erectile dysfunction is a common problem affecting up to 30 percent of men above 40 years old. Cardiovascular risk factors are closely associated with the development of vasculogenic erectile dysfunction. This explains the keen interest in identifying erectile dysfunction as a cardiovascular risk marker. A review of the literature reveals that erectile dysfunction has been shown to precede the development of coronary artery disease, and a number of hypotheses has been generated to support this association. Hence, it appears paramount that a complete assessment of erectile dysfunction would invariably involve assessment of cardiovascular risk factors and cardiac risk stratification. The Princeton III Consensus recommendation provides a straightforward guide for this purpose. The cardiologist should be involved early in the management of all patients with high cardiovascular risk, and some patients in the intermediate risk group.