Background and aims: Atherosclerosis is a diffuse and systemic disease. We aimed to assess prevalence and outcome of extracoronary polyvascular disease (polyVD) in the asymptomatic Chinese community population. Methods: A random sample of 5440 participants aged 40 years or older were enrolled in the Asymptomatic Polyvascular Abnormalities Community Study from 2010 to 2011. Intracranial artery stenosis, extracranial artery stenosis, and lower extremity artery disease were detected by transcranial Doppler and duplex sonography, and by calculating the ankle brachial index. The study endpoints included the first occurrence of stroke, myocardial infarction (MI) and all-cause death. Results: PolyVD (two or three affected vascular territories) was found in 3.0% of the participants, and was significantly higher in men (4.3%). Over a median follow-up of 4.1 years, we identified a total of 247 events (4.7%), including 83 strokes (68 ischemic), 45 MIs and 134 all-cause deaths. After adjusting for age, gender and other potential confounders, we found a significant increase in risk of major cardiovascular events as well as all-cause death in participants with polyVD. In multivariate Cox regression analyses, the adjusted hazard ratios (HR) (95% confidence interval, CI) for the composite of stroke, MI and all-cause death for single and poly-vascular disease (compared with 0 vascular disease) increased from 1.58 (1.19-2.12) to 1.95 (1.26-3.03). Similarly, the adjusted HR (95% CI) for all-cause death for single and polyvascular disease increased from 1.53 (1.03-2.29) to 2.22 (1.27-3.86). Conclusions: PolyVD significantly increased the risk of major cardiovascular events and all-cause death in the asymptomatic community population. Performing invasive screening tests for polyVD is useful in the high-risk asymptomatic population. (C) 2017 Published by Elsevier Ireland Ltd.