Background: The Framingham (F) risk is often used for cardiovascular (CV) risk stratification in general population. Carotid ultrasound examination makes risk stratification more precise, but the cost limits its availability. Standard laboratory tests are sometimes not available in primary care. We sought to evaluate the relation of carotid plaque (CP), a surrogate marker of atherosclerosis, with metabolic syndrome (MS), F risk, the general CV (G) risk, and non-laboratory-based CV (NL) risk in subjects who visited outpatient clinic for health check-up. Methods: A total of 925 adults (mean age, 51 years; 280 women; 431 hypertensives) were examined. None had clinical atherosclerotic CV disease, diabetes, and current medication for hypertension or dyslipidemia. All underwent standard laboratory tests and carotid ultrasound examination. Laboratory-based CV risk (MS, F, and G) and NL risk measures were obtained. Results: Subjects with CP had higher age, SBP, fasting plasma glucose, total cholesterol, proportion of MS, F risk, G risk, and NL risk than those without CP. However, there were no significant differences in BMI, triglyceride, HDL cholesterol, sex distribution, and proportion of current smoker. There were progressive increases in proportions of subjects with CP with increasing F, G, and NL risks (all, p for linear trends <0.001). The area under a receiver operating curve for CP was 0.55, 0.63, 0.70, and 0.67 for MS, F risk, G risk, and NL risk, respectively. A logistic regression analysis revealed that NL risk >10% (odds ratio 4.05, 95% CI 1.95-8.44, p<0.001) and hypertension (odds ratio 1.59, 95% CI 1.17-2.16, p<0.005) were independent predictors of CP. Conclusion: This suggests that NL risk is a better predictor of CP than F risk. Thus, in primary care, NL risk may be helpful to identify high risk subjects in whom further laboratory testing for atherosclerosis is potentially needed.