Background and Purpose Increases in common carotid intima-media thickness (CC-IMT), as measured by B-mode ultrasonography, have been widely used in both population studies and clinical trials in the search for risk factors for early atherosclerosis progression and have been found to correlate with age and with high concentrations of low-density lipoprotein cholesterol, leukocytes, and hemoglobin. We have now investigated the relation between several baseline hemostatic and conventional risk factors and CC-IMT changes over 16 months in 64 patients with peripheral arterial disease randomly selected from the prospective PLAT study series. Methods Samples from 24 patients (37.5%) who showed increases in CC-IMT during the follow-up period were compared with those from 40 (62.5%) in whom CC-IMT remained unchanged. Results Baseline conventional risk factors and coagulation variables were similar in the two groups except for higher plasma concentrations of von Willebrand factor (vWF) (178.3±53.6% versus 141.2±53.7%, P =.01) and factor VII (FVII) (133.9±36.4% versus 107.0±27.3%, P =.001) in the patients with increased CC-IMT. CC-IMT increase correlated positively with plasma levels of FVII ( r =.31, P <.01) and vWF ( r =.31, P <.01). Multiple stepwise regression analysis identified FVII as the only independent variable associated with an increase in CC-IMT (β=.83, P =.01). Conclusions High plasma concentration of FVII and vWF may be associated with the progression of early carotid atherosclerosis in patients with peripheral arterial disease.