Background: Erectile dysfunction (ED) confers an independent risk for cardiovascular events and total mortality. Aortic pulse wave velocity (PWV) is an important predictor of cardiovascular events and all-cause mortality. We investigated whether PWV predicts major adverse cardiovascular events (MACE) in patients with ED beyond traditional risk factors.

Methods: MACE in relation to PWV were analyzed with proportional hazards models in 344 patients (mean age 56 years) without established cardiovascular disease.

Results: During a mean follow-up of 4.7 years (range 1–8.5), 24/344 participants experienced a MACE. ED population was divided into tertiles according to the PWV values (low tertile <7.6 m/s; middle tertile 7.6–8.8 m/s; high tertile >8.8 m/s). Kaplan–Meier survival analysis showed that PWV was associated with MACE and the difference between the tertiles was significant (Mantel log-rank test: 11.161; P=0.004, figure). Subjects in the highest PWV tertile had a 4-fold higher risk of MACE compared to those in the lowest PWV tertile (adjusted HR 3.97, P=0.035). A PWV value of 7.81 m/sec was associated with a negative predictive value (ability to “rule out” MACE) of 98.1 %. Addition of PWV to standard risk factors model yielded correct patient reclassification to higher or lower risk category by 27.6% (P=0.0332) in the whole cohort.

Conclusions: Higher aortic stiffness is associated with increased risk for a MACE in ED patients without known cardiovascular disease. Aortic PWV improves risk prediction when added to standard risk factors and may represent a valuable biomarker of prediction of cardiovascular disease risk in these patients.