Carotid intima-media thickness (CIMT) is a simple and inexpensive tool to assess the cumulative effect of atherosclerotic risk factors and is an independent predictor of future cardiovascular risk. CIMT is commonly used as a surrogate end point in research trials as a marker of atherosclerosis. However, new software programs have made CIMT a clinically practical examination for risk evaluation. CIMT correlates with cardiac risk factors and is an independent predictor of future myocardial infarction and stroke risk. Tests for subclinical atherosclerosis, such as CIMT, will help clinicians to more effectively identify the vulnerable patient who would benefit from aggressive prevention intervention.