Although several scoring systems for cardiovascular risk prediction are valuable in the assessment and management of asymptomatic individuals and patients, differences between predicted and actual events do exist. The concept of vascular aging as a cumulative measure of the impact of cardiovascular risk factors on the arterial wall has the potential to gauge an individual's overall cardiovascular risk. In this context, candidate arterial biomarkers, apart from proving an incremental predictive value over and above traditional risk factors, must fulfill stringent criteria in order to be integrated into clinical practice; these include calibration, discrimination and reclassification. Current evidence suggests that arterial stiffness fulfills the criteria for a biomarker of vascular aging, whereas central hemodynamics and carotid intima–media thickness are close. Endothelial function, although a valuable research tool, has shortcomings in terms of risk prediction, largely dependent on the methodological approach, which may make it less desirable as a biomarker.