1. Prevalence (%) Prevalence of CAC by Degree of cPB No Carotid Plaque cPB Tertile 1 cPB Tertile 2 cPB Tertile 3 (n=1,316) (n=1,498) (n=1,497) (n=1,497) Supplementary Figure 1. Prevalence of coronary artery calcium (CAC) groups by level of carotid plaque burden (cPB).

2. Supplementary Table 1A. Hazard Ratios (95% Confidence Interval) for Primary MACE Endpoint Associated with Coronary Calcification and Carotid Plaque Burden After Adjusting for Risk Factors and Both Imaging Modalities No AtherosclerosisTertile 1Tertile 2Tertile 3p-value (trend) CAC1.0 (ref)1.05 (0.46-2.40)1.38 (0.64-2.99)2.42 (1.16-5.05)0.01 cPB1.0 (ref)0.71 (0.29-1.77)1.26 (0.57-2.77)1.80 (0.84-3.90)0.03 Supplementary Table 1B. Hazard Ratios (95% Confidence Interval) for Secondary MACE Endpoint Associated with Coronary Calcification and Carotid Plaque Burden After Adjusting for Risk Factors and Both Imaging Modalities No AtherosclerosisTertile 1Tertile 2Tertile 3p-value (trend) CAC1.0 (ref)1.28 (0.78-2.08)1.31 (0.81-2.13)2.42 (1.54-3.80)<0.001 cPB1.0 (ref)1.41 (0.81-2.45)1.87 (1.10-3.16)2.25 (1.34-3.80)0.001 CAC – coronary artery calcification; cPB – carotid plaque burden; MACE – major adverse cardiovascular events; Hazard ratios generated from multivariable models adjusted for CAC, cPB, race, age and sex, diabetes mellitus, current smoking, body mass index, systolic blood pressure, anti- hypertensive use, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and use of lipid lowering drugs.

3. Supplementary Table 2A. Hazard Ratios (95% Confidence Interval) for Primary MACE Endpoint Associated with Coronary Calcification or Carotid Plaque Burden Based on Quartiles of Atherosclerosis No AtherosclerosisQuartile 1Quartile 2Quartile 3Quartile 4p-value (trend) CAC1.0 (ref)0.81 (0.30-2.16)1.22 (0.51-2.94)2.05 (0.95-4.42)3.64 (1.78-7.48)<0.001 cPB1.0 (ref)0.70 (0.25-1.93)1.46 (0.64-3.31)1.45 (0.64-3.25)2.53 (1.19-5.39)0.002 Supplementary Table 2B. Hazard Ratios (95% Confidence Interval) for Secondary MACE Endpoint Associated with Coronary Calcification or Carotid Plaque Burden Based on Quartiles of Atherosclerosis No AtherosclerosisQuartile 1Quartile 2Quartile 3Quartile 4p-value (trend) CAC1.0 (ref)1.23 (0.72-2.11)1.44 (0.86-2.42)1.88 (1.16-3.05)3.38 (2.16-5.30)<0.001 cPB1.0 (ref)1.45 (0.80-2.62)1.79 (1.03-3.12)2.60 (1.54-4.39)2.88 (1.71-4.83)<0.001 CAC – coronary artery calcification; cPB – carotid plaque burden; MACE – major adverse cardiovascular events; Hazard ratios for MACE associated with CAC or cPB quartiles generated from multivariable models adjusted for race, age, sex, diabetes mellitus, current smoking, body mass index, systolic blood pressure, anti-hypertensive use, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and use of lipid lowering drugs.

4. Supplementary Table 3 Categorical Net Reclassification Tables for Primary MACE Endpoint with CAC (top panel) and cPB (bottom panel) Classification According to the Framingham Risk ScoreReclassification Accounting for CACTotal No. Without EventsLowIntermediateHigh Low, < 10% in 10 yrs 2405 8135613797 Intermediate, 10%-20% in 10 yrs6153595141488 High, ≥ 20% in 10 yrs132108201441 Total number without events3152129812765726 With Events Low, < 10% in 10 yrs178732 Intermediate, 10%-20% in 10 yrs772539 High, ≥ 20% in 10 yrs12811 Total number with events25174082 Net Reclassification improvement0.19 Classification According to the Framingham Risk ScoreReclassification Accounting for cPBTotal No. Without EventsLowIntermediateHigh Low, < 10% in 10 yrs21339567083797 Intermediate, 10%-20% in 10 yrs5453995441488 High, ≥ 20% in 10 yrs116122203441 Total number without events2794147714555726 With Events Low, < 10% in 10 yrs1451332 Intermediate, 10%-20% in 10 yrs4122339 High, ≥ 20% in 10 yrs23611 Total number with events20 4282 Net Reclassification improvement0.14

5. Supplementary Table 4 Categorical Net Reclassification Tables for Secondary MACE Endpoint with CAC (top panel) and cPB (bottom panel) Classification According to the Framingham Risk ScoreReclassification Accounting for CACTotal No. Without EventsLowIntermediateHigh Low, < 10% in 10 yrs23818135393733 Intermediate, 10%-20% in 10 yrs6003544851439 High, ≥ 20% in 10 yrs126103191420 Total number without events3107127012155592 With Events Low, < 10% in 10 yrs41262996 Intermediate, 10%-20% in 10 yrs22125488 High, ≥ 20% in 10 yrs771832 Total number with events7045101216 Net Reclassification improvement0.16 Classification According to the Framingham Risk ScoreReclassification Accounting for cPBTotal No. Without EventsLowIntermediateHigh Low, < 10% in 10 yrs21079356913733 Intermediate, 10%-20% in 10 yrs5373885141439 High, ≥ 20% in 10 yrs113115192420 Total number without events2757143813975592 With Events Low, < 10% in 10 yrs40263096 Intermediate, 10%-20% in 10 yrs12235388 High, ≥ 20% in 10 yrs5101732 Total number with events5759100216 Net Reclassification improvement0.13

6. Net Reclassification Improvement Supplementary Figure 2. Clinical Net Reclassification Improvement for Primary and Secondary MACE Endpoints with coronary artery calcium (CAC) and carotid plaque burden (cPB) in Intermediate Risk Subjects. Primary MACE Endpoint Secondary MACE Endpoint Clinical Net Reclassification with CAC or cPB Using Framingham Risk Score

7. Supplementary Table 5 Categorical Net Reclassification Tables for Primary MACE Endpoint with CAC (top panel) and cPB (bottom panel) Classification According to the Pooled Cohort Risk EquationsReclassification Accounting for CACTotal No. Without EventsLowIntermediateHigh Low, < 7.5% in 10 yrs 23737725253670 Intermediate, 7.5%-20% in 10 yrs 7284726411841 High, ≥ 20% in 10 yrs 5052110212 Total number without events 3151129612765723 With Events Low, < 7.5% in 10 yrs 178833 Intermediate, 7.5%-20% in 10 yrs 782338 High, ≥ 20% in 10 yrs 11911 Total number with events 25174082 Net Reclassification improvement0.17 Classification According to the Pooled Cohort Risk EquationsReclassification Accounting for cPBTotal No. Without EventsLowIntermediateHigh Low, <7.5% in 10 yrs 21039136543670 Intermediate, 7.5%-20% in 10 yrs 6395046981841 High, ≥ 20% in 10 yrs 5059103212 Total number without events 2792147614555723 With Events Low, < 7.5% in 10 yrs 1471233 Intermediate, 7.5%-20% in 10 yrs 592438 High, ≥ 20% in 10 yrs 14611 Total number with events 20 4282 Net Reclassification improvement0.14

8. Supplementary Table 6 Categorical Net Reclassification Tables for Secondary MACE Endpoint with CAC (top panel) and cPB (bottom panel) Classification According to the Pooled Cohort Risk EquationsReclassification Accounting for CACTotal No. Without EventsLowIntermediateHigh Low, < 7.5% in 10 yrs23507575073614 Intermediate, 7.5%-20% in 10 yrs7114606031774 High, ≥ 20% in 10 yrs4551105201 Total number without events3106126812155589 With Events Low, < 7.5% in 10 yrs40232689 Intermediate, 7.5%-20% in 10 yrs242061105 High, ≥ 20% in 10 yrs621422 Total number with events7045101216 Net Reclassification improvement0.17 Classification According to the Pooled Cohort Risk EquationsReclassification Accounting for cPBTotal No. Without EventsLowIntermediateHigh Low, < 7.5% in 10 yrs20808976373614 Intermediate, 7.5%-20% in 10 yrs6274826651774 High, ≥ 20% in 10 yrs485895201 Total number without events2755143713975589 With Events Low, < 7.5% in 10 yrs37232989 Intermediate, 7.5%-20% in 10 yrs173157105 High, ≥ 20% in 10 yrs351422 Total number with events5759100216 Net Reclassification improvement0.13

9. Net Reclassification Improvement Supplementary Figure 3. Clinical Net Reclassification Improvement for Primary and Secondary MACE Endpoints with coronary artery calcium (CAC) and carotid plaque burden (cPB) in Intermediate Risk Subjects. Primary MACE Endpoint Secondary MACE Endpoint Clinical Net Reclassification with CAC or cPB Using Pooled Cohort Risk Equations