Background and aims: Prediabetic subjects are at increased risk of cardiovascular (CV) events in comparison to subjects with normal glucose tolerance (NGT). Moreover, insulin resistance is a hallmark of prediabetes, and this characteristic is strictly bounded to CV risk. Thus, CV risk assessment is critical in subjects with prediabetes. Recently, triglyceride to high density lipoprotein cholesterol ratio (TG/HDL) and TG and fasting glucose (FG) product (TyG) have emerged as surrogate indexes of insulin resistance. Our aim was to evaluate the association of these indexes with CV risk evaluated through arterial stiffness in prediabetic subjects. Methods: 377 subjects without prior diagnosis of diabetes underwent: (1) metabolic evaluation via oral glucose tolerance test, FG, HbA1c, cholesterol, and TG dosage; (2) CV risk assessment through arterial stiffness. Then, subjects were split into three groups according to American Diabetes Association guidelines: NGT (N=100), prediabetes (pre-DM group [N=216]), and new onset type 2 diabetes (NODM) group (N=61). Results: Pulse wave velocity (PWV) was higher in pre-DM than NGT (7.8±1.6 vs 7.3±1.8 m/s, p=0.03), as well as augmentation index (AugI, 29.9±11.7 vs 25.2±12.9, p=0.001) and intima-media thickness (0.75±0.12 vs 0.68±0.11 mm, p<0.0001). Moreover, pre-DM subjects showed no difference in term of AugI in comparison with NODM. In addition, TG/HDL and TYG were higher in pre-DM than NGT (2.9±2.0 vs 2.3±1.7, p=0.008 and 4.6±0.2 vs 4.5±0.2, p=0.001), with no difference between pre-DM and NODM regarding TG/HDL. Finally, considering pre-DM, after multiple regression analysis (including age, sex, smoking status, body mass index, systolic blood pressure, low density lipoprotein cholesterol, C-reactive protein, FG, and HbA1c) PWV was independently associated with TG/HDL (β=0.20; p=0.02), but not with TyG. Conclusions: Prediabetic subjects presented a worse CV risk than subjects with NGT. Furthermore, in prediabetes TG/HDL showed an independent association with PWV, suggesting a possible role of this index for an easier assessment of cardiovascular risk.