Background: Erectile dysfunction (ED) has been reported as the first sign of a generalized vascular disease. Aortic stiffness and wave reflections are independent markers and prognosticators of cardiovascular risk. The association between ED and measures of aortic stiffness and wave reflections has not been investigated.

Methods: A total of 107 men with ED were evaluated for penile vascular disease severity by penile Doppler ultrasound: 40 men (aged 61±9 yrs) with coronary artery disease (CAD) and 67 men (aged 59±11 yrs) without CAD. Aortic stiffness was evaluated with carotid-femoral pulse wave velocity (PWV) and wave reflections with augmentation index (AIx) of the aortic pressure waveform using high-fidelity pulse wave analysis.

Results: Patients with CAD had decreased peak systolic velocity (PSV) (27 vs 34 cm/s, p = 0.001), and increased PWV (9.0 vs 8.4 m/s, p < 0.05) and AIx (30 vs 24%, p < 0.01) compared with men without CAD. PSV was correlated with age (r = −0.24, p < 0.05), Framingham risk score (r = −0.27, p < 0.05), PWV (r = −0.31, p = 0.001) and AIx (r = −0.33, p < 0.001). In multivariate linear regression models adjusting for age, height, heart rate, mean pressure and cardiovascular risk factors (BMI, total cholesterol, HDL, logCRP, hypertension, diabetes and intensity of smoking), penile Doppler results were significantly associated with both AIx (β = −0.265, p = 0.004) and PWV (β = −0.250, p = 0.009).

Conclusions: Our study shows that aortic stiffness and wave reflections correlate significantly with increasing severity of penile vascular disease as measured by penile Doppler. This finding provides further insights into the pathophysiology of ED and may have implications for the cardiovascular risk in these patients.