It is considered that the atherogenic index (AI), calculated from cholesterol fraction levels, is biochemically acceptable but cannot completely express the degree of physiological development of individual arteriosclerotic changes in extremely elderly persons. The purpose of this study is to search for another form of the atherosclerotic index which is more reliable in terms of physiological aspects, and to clarify the relationship between aortic pulse wave velocity (PWV) and AI in centenarians. We have measured the PWV in 40 healthy centenarians (7 males and 33 females; age 100 to 105, average age 101.1) and 92 ordinary elderly people (45 males and 47 females; age 70 to 89, average age 75.8) in Okinawa, Japan. The conventional AI was calculated by the Fridewald Method. A statistically significant difference in the AI value was observed between centenarians (1.91), and controls (2.59, p < 0.0001). Higher levels of PWV in centenarians (10.15 m/sec), were recognized than in the controls (8.45 m/sec, p < 0.0001). However, no significant correlations were noticed between PWV and AI in centenarians (r = 0.0049) and in controls (r = 0.094). These results suggested that pathological findings in centenarians are produced mainly by physiological fibrotic changes of the arterial wall instead of pathological atherosclerotic changes.