Several groups have demonstrated an association between established CHD and elevated oxidized LDL (oxLDL). The relation with cardiovascular risk factors and subclinical CVD is less clear. Therefore, we examined this association in the Multi-Ethnic Study of Atherosclerosis cohort: 879 persons without CHD, all non-statin users, examined cross-sectionally. oxLDL was measured with a monoclonal antibody 4E6-based ELISA. The presence of subclinical CVD was defined as plaque occurrence in carotid arteries with > or = 25 stenosis, ankle-brachial blood pressure index (ABI) < 0.9 and coronary calcification based on Agatston calcium score > or = 200. In a multivariate model, dyslipidemia (adverse levels of cholesterol, HDL-cholesterol, triglycerides), inflammation (elevated fibrinogen), gender (male), ethnicity (Black), and current smoking explained the most variation in oxLDL (model R2=0.41). In bivariate analyses, persons with subclinical CVD had higher levels of oxLDL (1.22 mg/dl versus 0.95 mg/dl; P=0.0002). Adjustment for risk factor correlates attenuated associations with subclinical CVD (P=0.026). In conclusion, oxLDL is associated with subclinical CVD by its relationship with many cardiovascular risk factors.