Background <p>Carotid Atherosclerosis is more prevalent among patients with coronary artery disease (CAD). To the best of our knowledge, research on the prevalence of carotid atherosclerosis in CAD patients is mainly based on retrospective cohorts or registries. We aimed to investigate the frequency of carotid atherosclerosis among patients with angiographically proven CAD and to investigate, whether carotid atherosclerosis is more prevalent in special subgroups.</p> Methods <p>We recruited consecutive patients with angiographically proven CAD, who presented to our cardiology department with manifestations of ischemic heart disease. Carotid atherosclerosis was assessed using ultrasound.</p> Results <p>We included 103 patients in our study. Eighty-three (80.6%) patients were males, the mean (± SD) age was 58 (± 9) years. Carotid atherosclerosis was detected in 74 (71.8%) patients. Of those, 6 patients (5.8%) had ≥ 50% stenosis. The ROC curve showed that a syntax score &gt; 17 had a sensitivity of 64.9% and a specificity of 72.4% for carotid atherosclerosis (AUC 0.68, 95% CI 0.57–0.79, <i>p</i> = 0.006). Using a multivariate binary logistic regression after adjusting for age and sex, we found that age ≥ 60 years (OR 5.1, 95% CI 1.64–15.86, <i>p</i> = 0.005), male sex (OR 3.61, 95% CI 1.03–12.67, <i>p</i> = 0.045) and ≥ 3-vessel CAD (OR 4.18, 95% CI 1.06–16.51, <i>p</i> = 0.04) were associated with carotid atherosclerosis. In another age- and sex dependent multivariate logistic regression, syntax score &gt; 17 independently predicted carotid atherosclerosis (OR 4.51, 95% CI 1.68–12.16, <i>p</i> = 0.003).</p> Conclusions <p>It seems to be reasonable to conduct carotid ultrasound screening for patients with CAD, especially older males with high syntax score and/or ≥ 3-vessel CAD.</p>