The study evaluates the association between arterial stiffness and cardiovascular events in the Framingham Heart Study. It examines the relationship between arterial stiffness measures, such as pulse wave velocity (PWV), wave reflection, and central pulse pressure, with the risk of first major cardiovascular disease (CVD) events, including myocardial infarction, unstable angina, heart failure, and stroke. The study included 2232 participants (mean age 63 years, 58% women) with a median follow-up of 7.8 years. During this period, 6.8% of participants experienced a CVD event. Higher aortic PWV was significantly associated with an increased risk of CVD events, with a 48% increase in risk per standard deviation (SD) increase in PWV. Adding aortic PWV to a standard risk factor model improved risk prediction, with an integrated discrimination improvement of 0.7%. In contrast, augmentation index, central pulse pressure, and carotid-brachial pressure amplification were not related to CVD outcomes in multivariable models. The study concludes that higher aortic stiffness, as measured by PWV, is associated with increased risk for a first cardiovascular event. Aortic PWV improves risk prediction when added to standard risk factors and may represent a valuable biomarker of CVD risk in the community. The study also highlights that central pulse pressure and wave reflection measures, such as augmentation index, do not provide incremental risk prediction beyond standard risk factors. The findings suggest that aortic PWV is a more specific marker of CVD risk compared to other measures of arterial stiffness. The study emphasizes the importance of aortic PWV as a potential novel biomarker for cardiovascular risk, given its strong association with CVD risk, its abnormality in a substantial proportion of middle-aged and older individuals, and its only modest correlation with standard risk factors. The study also notes that the combination of aging population, increasing aortic PWV with age, and increased risk with higher aortic PWV may lead to a major increase in the burden of disease potentially attributable to abnormal aortic stiffness. These findings suggest a need to identify and implement interventions that limit or reverse arterial stiffening in older people.The study evaluates the association between arterial stiffness and cardiovascular events in the Framingham Heart Study. It examines the relationship between arterial stiffness measures, such as pulse wave velocity (PWV), wave reflection, and central pulse pressure, with the risk of first major cardiovascular disease (CVD) events, including myocardial infarction, unstable angina, heart failure, and stroke. The study included 2232 participants (mean age 63 years, 58% women) with a median follow-up of 7.8 years. During this period, 6.8% of participants experienced a CVD event. Higher aortic PWV was significantly associated with an increased risk of CVD events, with a 48% increase in risk per standard deviation (SD) increase in PWV. Adding aortic PWV to a standard risk factor model improved risk prediction, with an integrated discrimination improvement of 0.7%. In contrast, augmentation index, central pulse pressure, and carotid-brachial pressure amplification were not related to CVD outcomes in multivariable models. The study concludes that higher aortic stiffness, as measured by PWV, is associated with increased risk for a first cardiovascular event. Aortic PWV improves risk prediction when added to standard risk factors and may represent a valuable biomarker of CVD risk in the community. The study also highlights that central pulse pressure and wave reflection measures, such as augmentation index, do not provide incremental risk prediction beyond standard risk factors. The findings suggest that aortic PWV is a more specific marker of CVD risk compared to other measures of arterial stiffness. The study emphasizes the importance of aortic PWV as a potential novel biomarker for cardiovascular risk, given its strong association with CVD risk, its abnormality in a substantial proportion of middle-aged and older individuals, and its only modest correlation with standard risk factors. The study also notes that the combination of aging population, increasing aortic PWV with age, and increased risk with higher aortic PWV may lead to a major increase in the burden of disease potentially attributable to abnormal aortic stiffness. These findings suggest a need to identify and implement interventions that limit or reverse arterial stiffening in older people.