Objective  To explore the association between erectile dysfunction (ED) and risk of coronary heart disease (CHD), thus providing a theoretical basis for identifying the potential clinical value of ED in CHD risk prediction.

Methods  The English-language cohort studies on the association between ED and CHD published worldwide were systematically retrieved from PubMed, Web of Science, Scopus, and Embase, supplemented by reference tracing, with the time interval from database inception to September 11, 2025. A meta-analysis of the included studies was performed in Stata 18.0.

Results  Finally, 7 cohort studies involving 14 397 participants with 1 395 incident cases of CHD were included. Meta-analysis showed that individuals with ED had a CHD risk 1.41 fold (RR=1.41, 95%CI: 1.28–1.56) of that among those without ED. Subgroup analyses revealed that ED was associated with an increased risk of CHD across subgroups stratified by age (≤70 years vs. >70 years), follow-up duration (≤5 years vs. >5 years), and ED diagnostic criteria (5-item International Index of Erectile Function IIEF-5 vs. self-reported ED), with all P-values < 0.05. Sensitivity analyses and tests for publication bias indicated no significant publication bias among the included studies, and the overall results were robust and stable.

Conclusions ED may be associated with an elevated risk of CHD.