Objectives: Cardiovascular risk stratification could be improved by adding measures of atherosclerosis to current risk scores, especially in intermediate-risk individuals. We prospectively evaluated the additive value of different non-invasive risk markers (both individual and combined) for gender-specific cardiovascular risk stratification on top of traditional risk factors in a middle-aged population-based cohort. Methods: Carotid-plaques, intima-media-thickness (IMT), ankle-brachial-index (ABI), pulse-wave-velocity (PWV), augmentation-index (AIx), central-augmented-pressure (CAP), and central-systolic-pressure (CSP) were measured in 1367 cardiovascular disease (CVD) free participants aged 50-70 years. Cardiovascular events were validated after a mean follow-up of 3.8 years. Area-under-the-curve (AUC) and net-reclassification-improvement-analyses (total-NRI for all and clinical-NRI for intermediate-risk groups) were used to determine the additive value of individual and combined risk markers. Results: Cardiovascular events occurred in 32 women and 39 men. Traditional cardiovascular risk factors explained 6.2% and 12.5% of the variance in cardiovascular disease in women and men, respectively. AUC's did not substantially increase by adding individual or combined non-invasive risk markers. Individual risk markers only improved reclassification in intermediate-risk women and more than in men; clinical-NRI's ranged between 48.0%-173.1% in women and 8.9%-20% in men. Combined non-invasive-risk markers improved reclassification in all women, and even more in those at intermediate risk; "IMT-presence-thickness-of-plaques" showed largest reclassification (total-NRI=33.8%,p=0.012; IDI=0.048,p=0.066; clinical-NRI=168.0%). In men, combined non-invasive risk markers improved reclassification only in those at intermediate risk; "PWV-AIx-CSP-CAP-IMT" showed largest reclassification (total-NRI=14.5%,p=0.087; IDI=0.016,p=0.148; clinical-NRI=46.0%). Conclusions: In all women cardiovascular risk stratification improved by adding combinations and in women at intermediate risk also by adding individual non-invasive risk markers. The additive value of individual and combined non-invasive risk markers in men is limited to men at intermediate risk only, and to a lesser extent than in women.