This study investigates the relationship between arterial stiffness and cardiovascular events in a community-based sample of 2232 participants from the Framingham Heart Study. The researchers used proportional hazards models to analyze the association between arterial stiffness (pulse wave velocity, PWV), wave reflection (augmentation index, carotid-brachial pressure amplification), and central pulse pressure with the first-onset major cardiovascular disease (CVD) events (myocardial infarction, unstable angina, heart failure, or stroke). During a median follow-up of 7.8 years, 151 participants (6.8%) experienced a CVD event. Higher aortic PWV was associated with a 48% increase in CVD risk (95% CI, 1.16 to 1.91 per SD, P=0.002). Adding PWV to a standard risk factor model improved integrated discrimination improvement by 0.7% (95% CI, 0.05 to 1.3%, P<0.05). However, augmentation index, central pulse pressure, and pulse pressure amplification were not related to CVD outcomes in multivariable models. The findings suggest that aortic PWV is a valuable biomarker of CVD risk and may improve risk prediction when added to standard risk factors.This study investigates the relationship between arterial stiffness and cardiovascular events in a community-based sample of 2232 participants from the Framingham Heart Study. The researchers used proportional hazards models to analyze the association between arterial stiffness (pulse wave velocity, PWV), wave reflection (augmentation index, carotid-brachial pressure amplification), and central pulse pressure with the first-onset major cardiovascular disease (CVD) events (myocardial infarction, unstable angina, heart failure, or stroke). During a median follow-up of 7.8 years, 151 participants (6.8%) experienced a CVD event. Higher aortic PWV was associated with a 48% increase in CVD risk (95% CI, 1.16 to 1.91 per SD, P=0.002). Adding PWV to a standard risk factor model improved integrated discrimination improvement by 0.7% (95% CI, 0.05 to 1.3%, P<0.05). However, augmentation index, central pulse pressure, and pulse pressure amplification were not related to CVD outcomes in multivariable models. The findings suggest that aortic PWV is a valuable biomarker of CVD risk and may improve risk prediction when added to standard risk factors.