Background: The ankle brachial index (ABI) is related to risk of cardiovascular events independent of the Framingham risk score (FRS). The aim of this study was to develop and evaluate a risk model for cardiovascular events incorporating the ABI and FRS. Design: An analysis of participant data from 18 cohorts in which 24,375 men and 20,377 women free of coronary heart disease had ABI measured and were followed up for events. Methods: Subjects were divided into a development and internal validation dataset and an external validation dataset. Two models, comprising FRS and FRS+ABI, were fitted for the primary outcome of major coronary events.