BACKGROUND AND AIMS: Although existing evidence suggests that arterial stiffness and obesity impact cardiovascular health, limited studies have been conducted to explore the association between brachial-ankle pulse wave velocity (baPWV), obesity-related indices, and the risk of atherosclerotic cardiovascular disease (ASCVD). METHODS AND RESULTS: The study participants were among those who completed the baPWV measurement at the second follow-up examination (during 2018-2020) of the Rural Chinese Cohort Study. Logistic regression models were employed to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) of the 10-year incident risk score of ASCVD associated with baPWV and obesity-related indices. Mediation analysis was applied to investigate the role of baPWV in the obesity-induced 10-year incident risk score of ASCVD. A total of 1589 individuals, including 573 men and 1016 women, were included in the study. In logistic regression analyses, the highest quartile levels of baPWV and obesity-related indices all significantly increased the 10-year incident risk score of ASCVD compared to their corresponding lowest quartiles. The ORs (95%CIs) of ASCVD 10-year incident risk score risk were 4.21(2.55-6.94) for baPWV, 4.43(2.69-7.29) for METS-VF, 7.20(4.09-12.66) for CVAI, 3.38(2.12-5.38) for CI, and 2.40(1.54-3.75) for ABSI. The indirect effect of baPWV accounted for 5.85 %, 7.92 %, 14.56 %, and 5.08 % of the total effects for METS-VF, CVAI, CI, and ABSI, respectively. CONCLUSION: This study found that elevated levels of both baPWV and obesity-related indices were associated with a higher 10-year incident risk score of ASCVD. Additionally, baPWV partially mediated the obesity-related increase in 10-year incident risk score of ASCVD.