BACKGROUND AND OBJECTIVES: Carotid intima media thickness (IMT) is associated with an increased risk of cardiovascular events whereas the Framingham risk score (FRS) is globally used to evaluate cardiovascular risk. We sought to evaluate the relationship between carotid IMT and FRS in Korean patients with coronary arteriosclerosis. SUBJECTS AND METHODS: The study population consisted of angiographically proven 267 consecutive patients with coronary arteriosclerosis (mean age 59 years, 141 males). Carotid IMT was measured by high-resolution ultrasound and semiautomatic methods. The FRS was derived from the algorithm published in the National Cholesterol Education Program Adult Treatment Panel III guidelines (NCEP-ATP III) using age, gender, smoking, systolic blood pressure level, use of antihypertensive treatment and total and high-density lipoprotein cholesterol levels. RESULTS: Carotid IMT correlated with the FRS in men (r=0.307, p<0.001) and in women (r=0.429, p<0.001). The severity of CAD, which was graded on the number of stenosed major coronary arteries more than 50%, showed a significant positive correlation with the FRS (r=0.266, p<0.001) and carotid IMT (r=0.166, p=0.007). The mean value of the FRS in patients with carotid plaque was higher than in patients without carotid plaque (15.0+/-3.9 and 12.0+/-4.4, p<0.001). The FRS was independently associated with carotid IMT in men and women (beta=6.433, p=0.001 and beta=11.271, p<0.001, respectively). CONCLUSION: The FRS for primary prevention was significantly associated with carotid IMT even in patients with CAD and also a correlation with the severity of CAD. The FRS may be helpful to predict the prognosis in patients with coronary arteriosclerosis such as carotid IMT and a prospective cohort study may be required to certify the usefulness of the FRS.