OBJECTIVES: To determine whether older women with abdominal aortic calcification had a greater cardiovascular and all-cause mortality, as such data are limited in older adults. DESIGN: Prospective cohort study with a mean follow-up of 13 years. SETTING: Community-based sample with four US clinical centres. SUBJECTS: A total of 2056 women aged > or =65 years with abdominal aortic calcification assessed on baseline radiographs. MAIN OUTCOME MEASURE: Mortality rate (all, cardiovascular, cancer or other cause) adjudicated from death certificates and hospital records. RESULTS: The prevalence of abdominal aortic calcification increased with age, ranging from 60% at age 65-69 years to 96% at 85 years and older. Participants with aortic calcification were more likely to die during follow-up of any cause (47% vs. 27%) or a cardiovascular-specific cause (18% vs. 11%, both P < 0.001) than those without aortic calcification. In age-adjusted analyses, aortic calcification was associated with a greater rate of all-cause and cause-specific mortality (cardiovascular, cancer, and other, all P < or = 0.01). In analyses adjusted for age and cardiovascular risk factors, aortic calcification was associated with an increased rate of all-cause mortality (HR: 1.37, 95% CI: 1.15-1.64), and noncardiovascular noncancer mortality (HR: 1.57, 95% CI: 1.17-2.11). The associations between aortic calcification and cancer mortality (HR: 1.44, 95% CI: 1.00-2.08) or cardiovascular mortality (HR: 1.18, 95% CI: 0.88-1.57) showed a similar pattern without reaching statistical significance, but was slightly stronger for mortality from coronary heart disease (HR: 1.53, 95% CI: 0.91-2.56). CONCLUSIONS: Abdominal aortic calcification in older women is associated with increased mortality. Future research should examine potential mechanisms for this association.