The aim of this 8-year follow-up study was to investigate the role of conventional cardiovascular risk factors as predictors for asymptomatic femoral atherosclerosis. The authors also evaluated the association of insulin resistance with atherosclerosis in a cross-sectional setting. Cardiovascular risk factors of 118 subjects were studied at the baseline study in 1983-1985 in Kuopio, Finland. Femoral atherosclerosis, defined as a presence of plaques, was investigated by ultrasonography in the follow-up study in 1992-1993. In the univariate logistic regression analyses, age (p = 0.002), systolic and diastolic blood pressure (p = 0.002 and p = 0.013, respectively), total cholesterol (p = 0.005), low density lipoprotein (LDL) cholesterol (p = 0.005), total triglycerides (p = 0.033), LDL triglycerides (p = 0.033), apolipoprotein B (p = 0.045), and fasting plasma glucose (p = 0.011) had a significant association with the presence of femoral plaques. Plasma insulin levels and insulin sensitivity index, determined in 87 subjects by an intravenous glucose tolerance test and minimal model at the follow-up study, were not associated with femoral plaques. The results demonstrate that atherogenic lipid and lipoprotein pattern and blood pressure are strongly associated with femoral atherosclerosis, whereas insulin sensitivity and hyperinsulinemia seem not to play such a significant role.