Background. Brachial-ankle pulse wave velocity (baPWV) is an indicator of atherosclerotic cardiovascular risk and/or vascular damage. Methods. We measured ankle-brachial index (ABI) and baPWV (Colin Co) in 190 pts with coronary artery disease (CAD). Virtual Histology intravascular ultrasound (VH-IVUS) imaging was available in target lesions of 52 pts with symptomatic CAD who were divided into two groups: baPWV >1600cm/sec (28 pts) and baPWV <1600cm/sec (24 pts). Results. . Pt age was 66짹7.68 yrs in baPWV >1600 group vs 55짹12.14 yrs in baPWV <1600 group (p=0.00029). While vessel size, lesion length, plaque burden, and remodeling index were similar, minimal lumen area (MLA) was smaller in baPWV >1600 (p=0.038, Table). VH-IVUS analysis of coronary artery plaque composition showed %max NC was similar (p=0.545), but %max calcium was higher in the baPWV >1600 group (p=0.041), and %maximal calcium correlated with baPWV (r=0.354, p=0.011). Conclusion. High baPWV indicated more severe CAD (smaller MLA) and greater atherosclerosis disease complexity (more calcified coronary plaque).