Objectives. The main aim of the present study was to examine the relationship between plaque occurrence and size, assessed by B-mode ultrasound in the carotid arteries, cardiovascular risk factors and the development of clinical cardiovascular disease. A further exploratory aim was to assess the relationship between plaque echogenicity and the development of cardiovascular disease. Methods. The carotid arteries were examined bilaterally by high-resolution B-mode ultrasound in 391, 58-year old men, identified by screening in the city of Göteborg, Sweden. Assessment of plaque occurrence, plaque size (No, Small, Moderate/Large) and plaque characteristics in terms of echogenicity (no plaque, predominantly echogenic or predominantly echolucent) were performed. Results. Systolic blood pressure was significantly associated with plaque occurrence at baseline [odds ratio (OR): 2.31, 95% CI = 1.51 to 3.55]. Total cholesterol and systolic blood pressure (SBP) were significantly associated with cardiovascular events during follow-up (total cholesterol, β = 1.2011, SE = 0.5243, p = 0.0220; SBP, β = 1.5171, SE = 0.5658, p = 0.0073, respectively). The OR for suffering cardiovascular events among subjects with plaques were 1.64 (95% CI = 0.63 to 4.26). Conclusions. SBP was a significant predictor for plaque occurrence at baseline. Total cholesterol and SBP, but not plaque occurrences were both significant predictors of cardiovascular events during follow-up. The study had limited power to detect the impact of plaque echogenicity on risk.