Background: We investigated whether heart-femoral pulse wave velocity (hfPWV) is better than carotid intima-media thickness (cIMT) in the prediction of the presence and severity of CAD. Methods: We prospectively enrolled subjects who were scheduled for coronary angiography. Subjects without heart failure, acute myocardial infarction, arrhythmia, previous coronary revascularization and peripheral artery disease, were analyzed (n=309; 59 짹 11 years; 176 men). hfPWV (VP-2000, Colin, Japan) and cIMT (M���ATH, France) were measured before coronary angiography. Severity of CAD was assessed using modified Genisini stenosis score (GSS) with the assistance of quantitative coronary analysis (QCA). CAD was defined as diameter stenosis >75%. Results: Both hfPWV and cIMT showed a significant correlation with GSS (correlation coefficient, hfPWV 0.28, cIMT 0.23; p<0.001). In multivariate regression analysis, hfPWV was correlated with GSS with adjustment for hypertension, diabetes, smoking, age, gender, body mass index, level of total cholesterol and the use of beta blockers, calcium antagonists, ACE inhibitors and ARBs (beta=0.142, p=0.038), but not cIMT (beta=0.094, p=0.139). In multivariate logistic regression analysis, hfPWV was associated with the presence of CAD (OR=1.21, 95%CI 1.07~1.38; p=0.003) and OR for the difference between the first and third tirtile was 2.60 (95%CI=1.21~5.58; p=0.014). However, cIMT was not associated with the presence of CAD (OR=1.02, 95%CI=0.99~1.05; p=0.110), and OR for the difference was 1.33 (95%CI 0.68~2.59; p=0.405). The area under a receiver operating characteristic curves was 0.666 for hfPWV and 0.617 for cIMT. Conclusion: Measurement of hfPWV may be better than measurement of cIMT as a surrogate marker for the presence and severity of CAD.