The major pathophysiologic process initiating atherosclerotic cardiovascular disease is the deficiency of arterial endothelial function. The rate of progression of cardiovascular disease is highly variable. Changes in small arterial elasticity/stiffness are the first signs of cardiovascular disease in asymptomatic subjects as an expression of endothelial dysfunction. Measurement of arterial stiffness with different noninvasive techniques provides information about the functional and structural vascular changes at the level of the aorta, the muscular conduit arteries, the peripheral branches, and the microvascular components. Arterial stiffness has been related to the coronary heart disease risk scores. Now, there is evidence that arterial stiffness is a predictor for cardiovascular events in the general population, in patients with hypertension, end-stage renal disease, and impaired glucose intolerance. Future studies are warranted to demonstrate the value of follow-up of arterial elasticity/stiffness as a marker of improvement in arterial wall health during antihypertensive, antidiabetic, and lipid-lowering therapy. Promising study results show that measurement of arterial stiffness can become an important part of the routine assessment of patients in daily practice.