Vascular diseases are associated with falls in older adults (>65 years), but this relationship is not well understood in middle‐aged adults. This study aimed to determine if balance in middle‐aged adults with poor ankle brachial pressure index (ABPI) was impaired compared to those with normal ABPI. We hypothesized middle‐aged adults with vascular disease, measured through ABPI, will fail the Romberg Balance Test at a higher rate compared to those without vascular disease. Data was collected from the 1999‐2000 and 2001‐2002 National Health and Nutrition Examination Survey. Good balance was determined by passing the 4th condition of the Romberg Balance Test; failure wad defined as not passing the 4th condition or any of the preceding conditions. Poor ABPI was classified as ≤0.90 and normal ABPI as >0.90. Middle‐aged adults (50.1 ± 0.23) with poor ABPI have a higher frequency of poor balance (4.2%) compared to good balance (1.3%; p=0.001). Further, individuals with poor ABPI have 3.38 (CI: 1.66, 6.87; p=0.001) times the odds of having poor balance compared to individuals with normal RABPI, which remained significant after adjusting for age and body mass index. Individuals who are at a greater risk for cardiovascular disease, as assessed by ABPI, have higher odds of poor balance. Thus, poor balance appears to be a characteristic of middle‐aged individuals at risk for cardiovascular disease.