Vascular erectile dysfunction (ED) is a significant predictor of cardiovascular disease (CVD) events, according to data from MESA. Investigators identified 1,757 individuals with ED on the basis of an answer to a questionnaire and who had no history of CVD events (myocardial infarction, stroke, resuscitated cardiac arrest, and stroke or cardiac death). During 3.8 years of follow-up, the rate of CVD events was higher in participants with ED than in those without ED (6.3% versus 2.6%; P < 0.001). In a model fully adjusted for traditional CVD risk factors, depression, and β-blocker use, ED was a significant predictor of CVD events (HR 1.9, 95% CI 1.1–3.4). ED and CVD have shared risk factors (obesity, hypertension, metabolic syndrome, diabetes mellitus, and smoking) and pathological mechanisms (endothelial dysfunction, inflammation, and atherosclerosis). The presence of ED could, therefore, have important implications for CVD risk stratification in middle-aged men.