Erectile dysfunction (ED) is common among patients with cardiovascular diseases (CVD). Sexual problems usually precede the onset of CVD and should, therefore, be considered as a risk factor for cardiac events. Similarly, patients with preexisting CVD are at increased risk of experiencing ED. Therefore, ED and CVD might be considered as two different clinical manifestations of the same systemic disease. Moreover, these conditions share many common pathophysiological mechanisms. Patients with preexisting CVD and ED should be stratified according to their cardiovascular risk. Sexual activity is safe in patients at low risk of CVD and these individuals might be treated with pro-erectile medications. On the other hand, men at high risk of CVD should be reassessed and the cardiac condition should be stabilized before they might have sexual attempts. Recent evidence suggests that lifestyle changes, administration of phosphodiesterase type-5 inhibitors, and testosterone supplementation might improve sexual function and reduce the risk of experiencing CVD during follow-up
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