We prospectively examined whether vascular factors are related to an increased incidence of Chronic Idiopathic Distal Symmetric Neuropathy (CI-DSN) in a non-diabetic elderly population. In 8 Italian municipalities, 2,512 men and women without both diabetes and CI-DSN at baseline are examined. Potential effect of vascular factors was estimated by regressing new onset CI-DSN on the occurrence of several vascular diseases and risk factors. Multivariate relative risks of CI-DSN were estimated by Cox proportional hazards models. After 3.8 (±2.4) years of follow-up, we documented 51 incident CI-DSN cases. At univariate analysis, age, comorbidity, waist circumference, leg length, peripheral artery disease, and coronary heart disease proved to increase the risk of developing CI-DSN. By multivariate analyses, only age (RR = 1.08; 95 % CI, 1.02-1.14), leg length (RR = 1.05; 95 % CI, 1.01-1.1) and peripheral artery disease (RR = 2.75; 95 % CI, 1.15-6.56) proved significant predictors of CI-DSN. Separate analyses by gender show that age is an independent predictor of CI-DSN both in men and in women, while PAD predicts the disease only in men, together with body height. Incidence of CI-DSN is higher in individuals carrying vascular conditions. In men, the presence at baseline of peripheral artery disease is associated with a threefold increase in the risk of developing CI-DSN. The incidence of neuropathy in non-diabetic individuals is associated with potentially modifiable vascular factors.