Understanding the impact of early vascular aging (EVA) on acute ischemic stroke (AIS) outcomes may provide new insights for improving prognostic assessments and developing targeted therapeutic strategies. This study aimed to validate the EVA ambulatory score (EVAAs) in AIS patients, assessing its association with stroke type, severity, and prognosis. Among the 2,730 AIS patients with a mean age of 72.0 ± 14.4 years, 83.4% exhibited EVA. EVA was identified as an independent predictor of poor outcome at both discharges (aOR:1.72, 95%CI:1.25-2.36, p <
0.001) and at 90 days (aOR:2.22, 95%CI:1.49-3.31, p <
0.001). In subgroup analyses, EVAAs showed improved predictive value in AIS patients with a lower cardiovascular disease burden and a non-atherogenic lipid profile. The EVAAs, as an indicator of EVA that could be easily integrated into daily clinical practice, are a significant predictor of adverse outcomes in AIS patients.