Identification of vasculogenic erectile dysfunction (ED) should be used to focus preventive efforts on reducing the risk of future cardiovascular events. For younger men 40 to 60 years old believed to have predominantly vasculogenic ED, we recommend an algorithm for further assessment of cardiovascular disease modified from the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) risk assessment guidelines. We propose that all men with confirmed vasculogenic ED and no overt cardiovascular disease symptoms undergo noninvasive evaluation using a coronary artery calcium (CAC) score. For men with low to intermediate risk (atherosclerotic cardiovascular disease (ASCVD) risk score 0–10 %), CAC score can be used to guide decisions regarding initiation of therapies, and in patients with high CVD risk, after referral to a cardiologist for a full evaluation, CAC can be used to guide intensity of therapies. We recommend that men with ED be evaluated using this modified risk assessment to incorporate factors otherwise excluded from the ACC/AHA calculator. © 2015, Springer Science+Business Media New York.