Purpose <p>Analyzing the correlation between carotid stiffness and atherosclerotic cardiovascular disease (ASCVD) risk, and determine elastic modulus (EM) threshold.</p> Methods <p>In this single-center, cross-sectional retrospective observational study, 229 patients without carotid plaque were consecutively enrolled between July 2021 and August 2022. ASCVD risk was calculated by simpler Framingham model and categorized into low (<i>N</i> = 108), moderate (<i>N</i> = 58) and high risk groups (<i>N</i> = 63). Shear-wave elastography was used to quantify carotid stiffness, and the resulting values were analyzed for their association with ASCVD risk.</p> Results <p>Among 229 participants without carotid plaque, 108 (47.2%), 58 (25.3%), and 63 (27.5%) were categorized as low, moderate, and high ASCVD risk, respectively. Carotid stiffness parameters (Emean and Emax) were significantly lower in the low-risk group compared with moderate- and high-risk groups (<i>p</i> &lt; 0.05), with no significant differences between the latter two groups. Multivariable linear regression revealed that each one-level increase in ASCVD risk category was independently associated with increased Emean (β = 0.933&#xa0;kPa, <i>p</i> &lt; 0.001), Emax (β = 1.222&#xa0;kPa, <i>p</i> = 0.005), and Emin (β = 0.564&#xa0;kPa, <i>p</i> = 0.011). All three stiffness parameters independently predicted cardiovascular events: Emean (OR = 1.105, 95%CI:1.009–1.211), Emax (OR = 1.067, 95%CI:1.002–1.136), and Emin (OR = 1.129, 95%CI:1.005–1.267). For CVD detection, Emean demonstrated optimal specificity (0.795) at a cutoff of 8.177&#xa0;kPa (AUC = 0.629), whereas ASCVD risk category alone achieved an AUC of 0.644 (sensitivity 0.717, specificity 0.528). Combined models improved specificity but reduced sensitivity without significantly enhancing AUC values.</p> Conclusion <p>EM was associated with ASCVD risk in this exploratory cohort; whether it can reliably distinguish risk categories awaits prospective validation.</p>