Background: Arterial stiffness, carotid intima-media thickness (C-IMT) and urinary albumin excretion are markers of vascular damage, independent of conventional cardiovascular disease (CVD) risk factors and risk predicting algorithm such as the Framingham risk score (F). We sought to evaluate the relation of these markers of vascular damage with F and general CV risk algorithm (G) which predicts combined CVD events. Methods: A total of 1,294 adults (mean age, 50 years; 402 women; 556 hypertensives) were examined. None had clinical atherosclerotic CVD, diabetes, and current medication for hypertension or dyslipidemia. Standard blood tests, heart-femoral (hf) and brachial-ankle (ba) pulse wave velocity (PWV) measurements, carotid ultrasound examinations, spot urine albumin-creatinine ratio (UACR) determinations were performed. Results: Pearson���s correlation coefficients for the relationship between G and PWV and C-IMT were almost 1.5 folds higher than those between F and PWV and C-IMT. The prevalence of the highest quartile of hfPWV, baPWV or C-IMT was progressively increased according to G or F quartiles (all, p <0.001 for linear trend). Each slope of increment was more pronounced for G compared with F. The prevalence of the highest quartile of UACR was also linearly increased according to G quartiles (p=0.023 for linear trend), whereas no such relation was observed between that and F quartiles (p=NS). Conclusion: This suggests that G is better associated with markers of vascular damage than F. Thus, in clinical practice, G may be helpful to identify high risk subjects in whom further laboratory testing for detection of subclinical vascular disease is potentially needed.