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Background: We aimed to evaluate the relationship between arterial stiffness and left ventricular diastolic dysfunction (LVDD) in metabolic syndrome (MetS) patients.Methods: A cross-sectional study was conducted in 1208 subjects without overt atherosclerotic disease. According to the cardiac ultrasound, patients were divided into two groups: with LVDD (LVDD+,n = 1119) and without LVDD (LVDD–,n = 89). Arterial stiffness parameters [carotid–femoral pulse wave velocity (cfPWV) and aortic augmentation index (AIxHR75)] were assessed by applanation tonometry.Results: In comparison to LVDD–, LVDD + patients were older (55 ± 6 vs 51 ± 6 years,p < 0.001), and had higher cfPWV (8.8 ± 1.6 vs 7.9 ± 1.34 m/s,p < 0.001), AIxHR75 (24.7 ± 10.2 vs 19.7 ± 10,p < 0.001), mean arterial pressure (108 ± 12 vs 101 ± 10 mmHg,p < 0.001), heart rate (66 ± 10 vs 61 ± 9 bpm,p < 0.001), left ventricular mass index (LVMI) (109 ± 24 vs 97 ± 22,p < 0.001) and body mass index (BMI) (32 ± 5 vs 30 ± 4 kg/m2,p < 0.001). We found significant correlations between cfPWV, AIxHR75 and the ratio of early to late transmitral velocities (E/A) (rcfPWV = –0.19,rAIxHR75 = –0.15,p < 0.001), early diastolic mitral annular velocity (E′) (rcfPWV = –0.25,rAIxHR75 = –0.18,p < 0.05) and E/E′ ratio (rcfPWV = 0.17,rAIxHR75 = 0.14,p < 0.001). Univariate analysis revealed that the presence of LVDD is associated with age [odds ratio (OR) 1.84], BMI (OR 1.63), waist circumference (WC) (OR 1.52), cfPWV (OR 2.18), AIxHR75 (OR 1.55), mean aortic blood pressure (OR 1.94), aortic pulse pressure (OR 1.78), mean common carotid artery intima–media thickness (OR 1.16), heart rate (OR 1.4) and LVMI (OR 1.79) (allp < 0.05). After performing stepwise multiple logistic regression analysis, only cfPWV and BMI or WC remained significant predictors of the presence of LVDD (p < 0.05).Conclusion: cfPWV is a significant determinant of LVDD in subjects with MetS. [ABSTRACT FROM PUBLISHER]