To evaluate the prevalence of carotid lesions and silent coronary artery disease in asymptomatic patients, we studied 31 subjects with one or more risk factors for atherosclerosis. All patients have been studied by means of non invasive cardiologic evaluations and carotid echo color Doppler. The prevalence of carotid and or coronary artery disease was 80%. The prevalence of silent coronary artery disease was 19% and carotid artery disease 61%. Patients with more than one risk factor showed a higher prevalence of carotid lesions (84%) than those with only one risk factor (16%). In conclusion, the prevalence of carotid disease in asymptomatic patients, at risk for atherosclerosis, is high. The echo color Doppler system represents the best approach to study carotid atherosclerosis in vivo. When carotid lesions are present, a non invasive cardiological evaluation may be useful to reveal a silent coronary artery disease.