BACKGROUND The aim of the present study was to investigate the relationship between carotid and aortic atherosclerosis in asymptomatic subjects. METHODS Eighty-three consecutive patients without history of cardio- and cerebrovascular disease, referred for transesophageal echocardiography, were enrolled into the study. RESULTS Aortic plaques were found in 40 out of 83 patients, whereas carotid atherosclerosis was present in 43% of the entire study population and in 75% of patients with aortic atherosclerosis (30 out of 40 patients). At multivariate logistic analysis, the presence of carotid atherosclerosis was a predictor of aortic atheroma, independently of traditional risk factors. CONCLUSIONS In asymptomatic patients, aortic plaque occurrence may reflect the presence of carotid plaques and an ultrasound assessment should be advised.