The prevalence of carotid atherosclerosis in the general population is variable. Also, the relationship between cardiovascular risk factors and carotid atherosclerosis has yet to be clearly defined. We carried out a cross-sectional study of 441 asymptomatic male subjects to investigate possible relationships between extracranial carotid plaques, cardiovascular risk factors and asymptomatic coronary obstructive disease. Carotid atheromatous plaques, detected by means of B-mode ultrasonography, were present in 31.7% of the study population. Prevalence and severity of atherosclerosis were significantly correlated with age, total cholesterol and signs of ischemia upon exercise stress test. However, hypercholesterolemia seemed to play a significant pathogenic role only in the youngest subjects (<55 years old). Our study confirms the high prevalence of asymptomatic carotid plaques in the general population, especially in elderly subjects. The only reversible risk factor related to carotid atherosclerosis is hypercholesterolemia, and this is reversible only at a young age.