Background: A recent meta-analysis concluded that augmentation index (AIx), a measure of pulse wave reflections influencing the central blood pressure, is related to mortality and cardiovascular disease (CVD) events and is likely to be clinically useful. However, prospective data based on non high-risk populations and women are lacking.Methods and results: In a random sample comprising 1300 men and 1773 women from Copenhagen, Denmark, AIx was measured non-invasively by use of the SphygmoCor device. The population was followed prospectively for a mean of 6.5 years for all-cause mortality and a combined CVD end point (time to first myocardial infarction, ischaemic cerebrovascular disease, percutaneous coronary intervention, coronary by-pass graft, or death from any cause). In men, hazard ratio (HR) in highest AIx tertile vs. lowest was 1.68 (95% CI 1.02-2.76) for all-cause mortality and 1.60 (95% CI 1.07-2.39) for the combined CVD end point after multivariable adjustment for CVD risk factors. In women, however, AIx was not related to either outcome with adjusted HR of 0.70 (95% CI 0.46-1.05) for all-cause mortality and 1.12 (95% CI 0.78-1.58) for the combined CVD end point.Conclusions: Our findings support that AIx relates to CVD in men but question the value in women. This gender differences may relate to different development in AIx with increasing age in men and women. Further studies are needed before AIx can be considered in CVD risk stratification or clinical practice.