Background: Erectile dysfunction (ED) has been considered as a clinical manifestation of a generalized arterial disease. Aortic stiffness and wave reflections are early markers of vascular changes associated with metabolic syndrome (MetS). We evaluated the possible association between aortic stiffness, wave reflections and ED in middle-aged patients with MetS.

Methods: Two groups of subjects with MetS (mean age: 48 years) were investigated:75 men with ED of vascular origin and 55 men with normal erectile function matched for age, body mass index (BMI), systolic and diastolic blood pressure, heart rate and smoking habits. MetS was defined according to the ATP III criteria. ED diagnosis and score were evaluated according to the International Index of Erectile Function (IIEF) questionnaire. Carotid-femoral Pulse Wave Velocity (PWV) was measured as an index of aortic stiffness and radial Augmentation Index (AIx) as a measure of wave reflections.

Results: PWV was higher in patients with ED than in the control group (8.3±1.1 vs 7.9±0.8 m/s, P<0.05); AIx did not differ (24.3±10 vs 23.9±11%, P=NS). To analyze the independent predictors of IIEF score, a stepwise linear regression analysis was performed using age, BMI, blood pressure, waist circumference, lipid profile, hsCRP and fibrinogen as independent variables. IIEF was independently associated only with PWV (beta=−0.273, t=−1.363, P=0.02).

Conclusion: In middle -aged subjects with MetS, the presence of ED is associated with a selective alteration of central PWV. This finding suggests that this group of patients may be at greater cardiovascular risk.