Objective To explore the predictive value of brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI) for major adverse cardiac and cerebrovascular events (MACCE). Methods Clinical data of 242 patients admitted to the Department of Geriatric Cardiology of First Affiliated Hospital of Nanjing Medical University from August 2008 to September 2014 were retrospectively analyzed, and the occurrence of MACCE was followed up. Patients were divided into MACCE group (n=125) and non-MACCE group (n=117) according to the occurrence of MACCE, and the clinical characteristics of the two groups were analyzed.The independent and combined predictive value of baPWV and ABI for MACCE were analyzed. SPSS statistics 29.0 was used for data analysis. Student′s t test or Mann-Whitney U test was employed for intergroup comparison according to data type, and Kaplan-Meier curve was adopted for survival comparison. Results The median follow-up time was 3.3 (2.6,4.2) years for the 242 patients, and 125 of them (51.7%) reached the main endpoint. Compared with non-MACCE group, the paitients of MACCE group were older, had higher baPWV, pulse pressure, blood uric acid, higher incidence of coronary heart disease and higher use of diuretic; while, ABI, toe brancial index (TBI) and diastolic blood pressure were lower, and the differences were statistically significant (P＜0.05). Multivariate Cox regression analysis indicated that baPWV (HR=1.000, P=0.012), ABI (HR=0.080, P=0.002) and diastolic blood pressure (HR=0.981, P=0.012) were independent predictors for MACCE. After ABI was added to the prediction model, both the area under ROC curve for predicting MACCE (0.674 and 0.717 respectively) and net reclassification index (NRI, 95%CI 0.029-0.061; P<0.001) were increased. Conclusion BaPWV and ABI are independent predictors for MACCE in elderly people, and their combination shows higher predictive value for MACCE occurrence.