We used ultrasonography to assess the accumulation of visceral fat and its relation to known risk factors for atherosclerotic disease, and examined its relation with atherotic changes in the common carotid artery. The subjects were 315 consecutive inpatients (173 men, 142 women; mean age, 68.3 years) hospitalized during a 21-month period. Those with a history of epigastric surgery or nutrition disorders that might affect fat thickness were excluded. A 7.5-MHz transducer was used to evaluate the maximum thickness of preperitoneal fat (Pmax) at the anterior surface of the liver, and the minimum thickness of subcutaneous fat (Smin) of the abdomen. The fat/height ratio was calculated. Age, gender, smoking status, blood pressure, total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, atherogenic index ((total cholesterol-HDL-cholesterol)/HDL-cholesterol), blood sugar, serum insulin, and uric acid were examined as confounders. Pmax/height was found to be related to systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol and atherogenic index, and was positively associated with the thickness of the common carotid arterial wall. Pmax/height may be a useful means to evaluate known risk factors for atherosclerotic disease.