Aim:To investigate the effect of smoking and smoking cessation on cardio-ankle vascular index (CAVI). Methods: The subjects were 82 smokers (77 men, 64 10 years) and 20 non-smokers (18 men, 61 7 years). CAVI was measured every 3 months and CAVI severity was classified into 3 levels. Decreased, unchanged, and increased CAVI severity levels were coded as "improvement," "no change," and "exacerbation," respectively. Smoking status was coded as "success" for complete abstinence, "partial success" for a reduced number of cigarettes, and "failure" for an unchanging number of cigarettes. Results: Compared with non-smokers, smokers showed a higher CAVI (p 0.05) prior to smoking cessation. Post-cessation, CAVI improved from 9.4 to 8.6 (p 0.01) in "success" cases (n 22), and the significant pre-cessation difference from non-smokers (n 20, CAVI 8.8) disappeared. With regard to the change in CAVI severity of each smoking status, "improvement" occurred in 17%, 24%, and 68% of "failure" (n 35), "partial success" (n 25), and "success" (n 22) groups, respectively, and the "success" group was significantly higher than the other two groups. Conclusion: The study showed that CAVI was increased by smoking, and complete smoking cessation improved CAVI. J Atheroscler Thromb, 2010; 17:517-525.