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Since erections depend on the blood vessels that serve the penis, it’s not surprising that vascular disease is the leading cause of ED. The most common type of vascular disease is atherosclerosis, which occurs when fatty deposits build up on artery walls, narrowing and clogging them (see Figure 5). Most people think of atherosclerosis as occurring mainly in the heart’s arteries. But in fact, it can occur in arteries throughout the body — including those in the penis. High blood pressure, high cholesterol, diabetes, and smoking all lead to atherosclerosis. Since atherosclerosis also raises the risk of having a heart attack, ED can be an early warning sign of possible heart and cardiovascular problems.