Cardiovascular disease is a major cause of morbidity and mortality in the western world. There is convincing evidence that the elastic properties, particularly of large arteries, are impaired in the presence of cardiovascular disease and risk factors such as cigarette smoking, hypertension, diabetes and ageing. Evidence is also emerging that treatment of these risk factors is associated with an improvement in the elastic properties, mirrored by a reduction in the cardiovascular risk and events. The main problems associated with arterial elasticity are the multiple definitions and methods of measurement and the problem of obtaining reliable nearby blood pressure measurement. Nevertheless, duplex estimation appears to be a non-invasive, accurate and reliable method of defining these properties. This method is broadly used as a research tool, but there is a good case for its use in clinical practice, particularly in the screening of patients at risk of cardiovascular events.