To determine whether a relationship between echographically assessed carotid artery and left ventricular (LV) structures existed in asymptomatic men at risk for cardiovascular disease, we evaluated carotid and LV parameters in 69 subjects (23-62 years) without LV hypertrophy. The right common carotid far wall intima-media thickness (IMT) was measured using an automated technique and the cross-sectional intima-media complex area (IMC-CSA) was calculated, assuming a circular profile of carotid wall layers, as (IMC-CSA = pi x IMT x (IMT + D)), D being the lumen diameter. LV mass was evaluated using the M-mode echocardiography. Among study subjects 30% were hypertensive, 67% hypercholesterolemic, 21% current smokers and 52% had a positive smoking history. In the study population LV mass correlated both with IMT (r = 0.54, P < 0.001) and IMC-CSA (r = 0.62, P < 0.001). In multivariate analysis LV mass was associated with IMC-CSA (P < 0.001), body mass index (P < 0.01), lifelong smoking dose (P < 0.01) and systolic blood pressure (P < 0.05), r(2) = 0.58, P < 0.001. Therefore, IMC-CSA may be a clinically relevant independent indicator of LV mass even within its normal ranges.