The major pathophysiologic process of coronary atherosclerosis is a defect or injury of the arterial endothelial function. The rate of progression of coronary atherosclerosis is highly variable and mainly determined by risk contributors such as lipids, glucose, and smoking. Coronary plaque rupture is the precipitating factor for clot formation and acute coronary events. Measurement of arterial stiffness with different noninvasive techniques provides information about the functional and structural vascular changes at the level of the aorta, muscular conduit arteries, the peripheral branches, and the microvascular components. Arterial stiffness has been related to the Framingham and other cardiovascular risk scores. Large artery stiffness contributes to exercise-induced myocardial ischemia in patients with coronary artery disease, it can predict the outcome after coronary interventions. There is now evidence that arterial stiffness is a predictor for cardiovascular events in the general population, in patients with hypertension, end-stage renal disease, impaired glucose intolerance, and coronary artery disease. Future studies are warranted to demonstrate the value of follow-up of arterial stiffness as a marker of reduction of arterial wall damage during antihypertensive, antidiabetic, and lipid-lowering therapy. Promising study results show that measurement of arterial stiffness could become an important part of the routine assessment of patients in daily practice.