Background: Pulse wave velocity (PWV) is a marker of arterial stiffness. Some studies have demonstrated that arterial stiffness progressively increases as left ventricular (LV) diastolic function decreases. Higher arterial stiffness is associated with increased risk for a first cardiovascular (CV) event. The aim of this study was to determine the association of PWV or LV diastolic function with the development of CV events. Methods and Results: Brachial-ankle PWV (baPWV) and E/E��� were analyzed in 185 patients (mean age, 62 years; 56% male). The primary endpoint was CV events including ischemic stroke, coronary arterial disease (CAD), peripheral arterial disease (PAD) and aortic dissection (AD). The mean baPWV was 1724짹454 cm/s and the mean E/E��� was 12.4짹3.6. The E/E��� correlated significantly with the baPWV (r = 0.24, P = 0.001). There were 30 CV events (13 ischemic strokes, 15 CAD, 1 PAD, 1 AD) during a mean follow-up of 19.8 months. When the baPWV cut-off level was set to 1704 cm/s using the ROC curve, the sensitivity was 70/92% and the specificity was 63/62% for differentiating between the group with and without CV events/ischemic stroke respectively. Kaplan-Meier analysis revealed that the higher baPWV group (���1704 cm/s) had significantly higher CV event and ischemic stroke rates than the lower baPWV group (<1704 cm/s) (26.9% vs. 8.4%, 15.4% vs. 0.9%, respectively, log-rank: P < 0.001). In univariate analysis with the Cox proportional hazard model, higher baPWV was a predictor for CV and ischemic stroke events (HR 3.43, 95% CI 1.57-7.50, P = 0.002, HR 17.34, 95% CI 2.26-133.39, P = 0.006). However, high E/E��� (> 15) was not a predictor for CV, ischemic stroke events or CAD. A higher baPWV was an independent predictor of CV and ischemic stroke risk after adjusting for age, sex, hypertension, and diabetes (HR 2.74, 95% CI 1.10-6.82, P = 0.031, HR 10.35, 95% CI 1.16-92.01, P = 0.036) in the Cox proportional hazard analysis. In subgroup analysis, diabetic patients with a baPWV over 1704 cm/s had high CV and ischemic stroke risk without antiplatelet agents (Log-Rank = 0.017, 0.002, respectively). Conclusions: The results of this study show that higher baPWV was a predictive marker for CV events, especially ischemic stroke. Subgroup analysis suggests that antiplatelet therapy may be needed in diabetic patients with a high baPWV for prevention of ischemic stroke.