Background: Erectile dysfunction (ED) has been reported as the first sign of a generalized vascular disease. Arterial stiffness may be an early marker for vascular changes associated with metabolic syndrome (MetS). We evaluated associations between ED, arterial stiffness and markers of systemic vascular inflammation and endothelial dysfunction in patients with MetS.

Methods: Two groups of subjects with MetS were investigated: 39 men (mean age: 59 yrs) with ED of vascular origin and 30 men (mean age: 57 yrs) with normal erectile function. Aortic stiffness was evaluated with carotid-femoral pulse wave velocity (PWV) using high-fidelity pulse wave analysis. Plasma levels of interleukin 1β (IL-1β), tumor necrosis factor-α (TNF-α) and soluble vascular cell and intercellular adhesion molecules (sVCAM-1, sICAM-1) were measured with ELISA.

Results: The mean erectile function score (IIEF-5) was 13 (range 6–20) in men with MetS and ED and 23 (range 22–25) in men with MetS and normal erectile function. ED patients had increased PWV compared to patients with normal erectile function (8.9 vs 8.3m/s, p < 0.05). Compared with men without ED, ED patients had significantly higher levels of C-reactive protein (CRP), (p < 0.05), IL-1β (p = 0.01), TNF-α (p < 0.01), sVCAM-1 and sICAM-1 (p < 0.05 for both). IIEF-5 score was negatively associated with PWV (r = −0.30, p = 0.01), CRP (r = −0.27, p < 0.05), IL-1β (r = −0.25, p < 0.05), TNF-α (r = −0.32, p < 0.01), sVCAM-1 (r = −0.24, p < 0.05) and sICAM-1 (r = −0.40, p < 0.001).

Conclusion: ED and aortic stiffness are related in men with MetS and may contribute to their raised cardiovascular risk through impaired endothelial function elicited by an increased vascular inflammatory state.