BACKGROUND: Reduced total arterial compliance (TAC) may be a marker of preclinical vascular disease. Irreversible risk factors such as age and body habitus are determinants of TAC, the importance of which may have been hidden by reports in selected subgroups, such as the elderly and those with diabetes mellitus or hypertension. We sought the comparative influence of reversible and irreversible risk factors on TAC in a large primary prevention group. MATERIALS AND METHODS: We studied 720 consecutive patients with and without cardiovascular risk factors but with no overt cardiovascular disease. TAC was calculated by the pulse-pressure method from simultaneous applanation tonometry and left ventricular outflow tract Doppler. Central pressure was derived using a transfer function from the radial tonometric waveform and calibrated using mean and diastolic brachial cuff pressure. RESULTS: There were 192 patients with no cardiovascular risk factors, 180 patients with one cardiovascular risk factor, 173 patients with two cardiovascular risk factors, and 175 patients with three or more risk factors. Although age, gender, height, weight, hypertension, diabetes mellitus, hyperlipidemia, and number of risk factors were all significantly associated with TAC, age accounted for approximately 13% of the variance, and the only other independent predictors were height and weight. TAC was not significantly different in age-matched subgroups with single risk factors. CONCLUSION: TAC is associated with multiple risk factors, but age is a major determinant. The influence of age and other correlates may dwarf the contribution of individual risk factors and therefore their alteration with therapy.