In this narrative review we have briefly revised the main epidemiological evidences on the relation between erectile dysfunction (ED) and cardiovascular risk factors and diseases. There are consistent epidemiological evidences which link ED and cardiovascular diseases, diabetes or cholesterol levels. Most of studies which have taken into account in the analysis of the relation between ED and hypertension, cardiovascular diseases, smoking and weight (or body mass index) have shown that these factors have an independent role on the risk of ED. Otherwise, ED is a risk factor for subsequent development of cardiovascular diseases. In the routine clinical practice the presence of ED should be considered a "marker" for the development of cardiovascular diseases. The physician should consider to ask each patient regarding the presence of ED in order to focus preventive measures.

Erectile dysfunction is a common complication of diabetes. Clinical practice has no treatment modality specifically designed for the difficult to treat diabetic erectile dysfunction due to the multifactorial and complex pathophysiology of development. PDE type 5 inhibitors are the first-line treatment option. Non-responders should have total and free testosterone checked and testosterone replacement is recommended for hypogonadal patients. For patients who cannot take PDE type 5 inhibitors, or are proven non-responders, the vacuum constriction device continues to serve as a major treatment option. Intracavernosal injection is the most effective medical therapy for diabetic erectile dysfunction despite its high dropout rate. Use of the Medicated Urethral System for Erection to overcome the disadvantages of needle injection is disappointing due to lack of effectiveness. Penile prosthesis will continue to play an important role in diabetic patients with severe erectile dysfunction in coming years.