Background and Aim: Premature arterial stiffening (AS) may contribute to macrovascular complications in diabetes. Cardiovascular autonomic neuropathy (CAN) and erectile dysfunction (ED) are also associated with adverse cardiovascular outcomes. The aim of this observational study was to investigate the relationships between CAN, ED and AS in men with diabetes.

Methods: Thirty male subjects with diabetes (type 1 and 2) (age range 39–74 yrs) but without overt cardiovascular disease were studied. AS and wave reflections were assessed by measuring pulse wave velocity (PWV) (carotid-femoral [cf] and carotid-radial [cr]) and augmentation index (AIX) (Sphygmocor). Cardiovascular autonomic function was assessed by measures of blood pressure and heart rate variability during continuous ECG recording following standard postural and breathing manoeuvres. Erectile function was evaluated using the validated International Index of Erectile Function IIEF-5 questionnaire.

Results: (Mean±SD); Comparing subjects with CAN (n = 16) versus subjects without CAN (n = 14), cfPWV was higher (10.8±2.8 m/s vs 8.9±1.5 m/s, p < 0.05) despite no differences in age, brachial blood pressure, erectile function, crPWV or AIX. Comparing subjects with severe ED (n = 17) versus normal erectile function (n = 13) there were no differences in arterial function despite higher systolic and diastolic blood pressure in subjects with severe ED. Multiple regression analysis (R² = 0.83, p < 0.01) identified CAN (autonomic score) (β = 0.66, p = 0.01) and ED (IIEF score) (β = −0.62, p = 0.014) as independent predictors of cfPWV but not of crPWV or AIX.

Conclusion: Both CAN and ED are independently associated with increased aortic stiffness in diabetes. CAN appears the stronger predictor and may exert a pathophysiological role in the process of aortic stiffening.