Objective. Vascular risk factors frequently coexist with lower urinary tract symptoms (LUTS) in both men and women, suggesting that atherosclerosis and endothelial dysfunction may play a major role in the development of LUTS. Arterial stiffness owing to decreased arterial compliance is one of the major signs of vascular ageing, and carotid intima-media thickness (CIMT) can be used in establishing the extent and severity of vascular impairment. This study investigated the association of arterial stiffness and vascular atherosclerotic involvement with LUTS in men and overactive bladder (OAB) in women. Material and methods. This study was prospective and cross-sectional, consisting of 66 patients with LUTS (38 men with LUTS, 28 women with OAB) and 62 controls without LUTS or OAB. Carotid-femoral pulse-wave velocity (CF-PWV) was measured as an index of arterial stiffness. CIMT was measured with B-mode ultrasonography to assess vascular impairment. Results. Patients with LUTS had significantly higher CF-PWV (9.8 +/- 2.6 vs 7.0 +/- 1.4 m/s, p < 0.001) and CIMT (0.89 +/- 0.16 and 0.56 +/- 0.31 mm, p < 0.001) compared with controls. Age and glucose were also different between LUTS and control groups (p < 0.001 and p = 0.003, respectively). In the multivariate analyses, both CIMT (= 0.429, p < 0.001) and PWV (= 0.451, p < 0.001) were related to LUTS. Conclusions. Vascular impairment was found to be associated with LUTS in both men and women. Atherosclerosis-related vascular risk factors are also known to be related to LUTS and both disorders may have pathogenic interactions.