The review demonstrates various patomechanisms of erectile dysfunction and evidence-based risk factors for this condition. Coronary artery disease, metabolic syndrome, hypogonadism and erectile dysfunction share many risk factors and may be a manifestation of the same metabolic disorder. Many other factors play an important role in pathophysiology of erectile dysfunction: psychogenic factor, lower urinary tract symptoms in BPH (benign prostate hyperplasia), pharmacological and surgical side-effects and life style. The Princeton III Consensus Conference influenced the guidelines algorithm for patients with erectile dysfunction and cardio vascular risk, highlighted benefits from modification of various common risk factors which in fact, may slow down the vicious metabolic circle and decrease the symptoms.