In a cohort of elderly people, aortic stiffness predicted major adverse cardiovascular events, enhancing the performance of a broadly employed cardiovascular disease risk estimator. Aortic pulse wave velocity measurement is scalable, radiation-free, and easy to perform.

• If aortic pulse wave velocity identifies people with higher risk of incident major adverse cardiovascular events and improved performance of the American Heart Association/American College of Cardiology atherosclerotic cardiovascular disease risk score was investigated.

• In this prospective study, a total of 3,837 Whitehall II cohort participants who were screened in 2008 to 2009, and followed for 11.7 years, without history of stroke, myocardial infarction, or coronary heart disease, were analyzed.

• A high risk (hazard ratio, 2.99) was observed in participants in the highest aortic pulse wave velocity quartile; they reached the threshold for statin medication (7.5% risk) after 5 years whereas others reached it after 10 years.

• As a result of adding aortic pulse wave velocity to the risk score, C statistic (0.68 vs 0.67) and net reclassification index (4.6% and 11.3%) improved.