The potential interest of serum elastase activity (SEA) as a marker of vascular aging and atherosclerosis was studied as part of an epidemiological study on vascular and cognitive aging (EVA Study). SEA was measured in 555 men and 774 women aged 59-71 years with a synthetic substrate, suc(ala)3pNA, according to a modified enzyme-linked immunosorbant assay (ELISA)-type procedure. The distribution of SEA-values was skewed to the right in men and women, the mean value was 0.52 +/- 0.55 U/ml in males and 0.43 +/- 0.52 U/ml for females. This difference could be entirely explained by alcohol consumption. SEA increased strongly with alcohol consumption in males and females. It was also positively and significantly correlated with body mass index (BMI) and systolic blood pressure (SBP). SEA significantly decreased with age in men and was not influenced by smoking in either sex. SEA was significantly increased in diabetic men compared with non-diabetics and a similar trend, although not significant, was observed in women. When both sexes were combined, the association between diabetes and SEA was independent of other clinical risk factors. No significant associations were observed with intima-media thickness or atherosclerotic plaques assessed by B-mode carotid ultrasonography. Among biological risk factors, triglycerides (in both sexes) and glucose (in men) appeared the strongest correlates of increase in SEA. In multivariate analysis, independent determinants of an increased SEA were age, alcohol consumption, triglycerides and glucose in men, and alcohol consumption and triglycerides in women.