Objectives.  To evaluate the incidence of coronary events (CE) and case fatality in relation to common carotid intima‐media thickness (IMT) and carotid plaque over a median follow up of 7 years.

Subjects.  A total of 5163 Swedish middle‐aged men and women with no prior myocardial infarction and/or stroke.

Methods and results.  The associations amongst B‐mode ultrasound determined common carotid IMT, carotid plaque (focal IMT > 1.2 mm) and carotid stenosis (lumen reduction of >15%) and incident CE, were investigated in relation to cardiovascular risk factor levels. Age‐ and sex‐adjusted common carotid IMT, carotid plaque and carotid stenosis were significantly (P < 0.05) related to future CE. Adjustment for established risk factors generally reduced the hazard rate ratios. However, the continuous measure of common carotid IMT, carotid plaque and carotid stenosis were significantly related to incident CE, even after risk factor adjustment. The strength of the associations between common carotid IMT and CE was only to a small extent reduced after adjustment for presence of carotid plaque. There were no statistically significant associations between common carotid IMT, carotid plaque or carotid stenosis and short‐term case‐fatality rates (28‐days mortality) or long‐term case‐fatality rates (5‐years mortality).

Conclusions.  The results show an association between common carotid IMT and incident CE, independently of cardiovascular risk factors and carotid plaque. However, there was no association with short‐term or long‐term mortality after a CE.