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Aortic stiffness is a feature of arterial aging and is associated with dismal cardiovascular prognosis. We examined whether central and general adiposity is an independent predictor of accelerated aortic stiffening 20 years later in initially healthy midlife individuals.Participants from the STANISLAS cohort study (826 initially healthy participants aged 30–60 from the Lorraine region in France) underwent clinical and biological measurements at baseline (1994–1995) and after ≈20 years (2011–2016). Adiposity measurements included waist circumference/BMI ratio, BMI, waist circumference, and ‘body shape index’ [waist circumference/(BMI2/3 height1/2)]. Real carotid–femoral pulse wave velocity (cfPWV) was measured at end of follow-up. Our primary analysis was to test the association between waist circumference/BMI ratio and cfPWV.In a multiple linear regression model adjusted for sex, age and mean arterial pressure, waist circumference -to-BMI ratio was positively associated (for 1SD increase) with higher cfPWV [regression coefficient β = 0.32, 95% confidence interval (CI) 0.19–0.45, P < 0.001]. The cfPWV was less strongly associated with body shape index (β = 0.17, 95% CI 0.022–0.32, P < 0.05) and negatively associated with BMI (−0.20, 95% CI −0.31 to −0.093, P < 0.001) and waist circumference (−0.14, 95% CI −0.28 to 0.00, P < 0.05). Sensitivity analyses demonstrated that the risk of cfPWV associated with waist circumference-to-BMI ratio remained significant after adjustment for heart rate, metabolic risk factors and inflammatory markers.Central adiposity (and more specifically waist circumference-to-BMI ratio) is an independent predictor of 20-year subsequent aortic stiffness in initially healthy midlife subjects.