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Our study examined whether osteocalcin contributed to identifying carotid intima-media thickness (C-IMT) over the atherosclerotic cardiovascular disease (ASCVD) risk score.We recruited 618 middle-aged and elderly men from communities in Shanghai. Serum osteocalcin levels were determined using an electrochemiluminescence immunoassay. C-IMT was measured by ultrasonography.The study included 245 men with low ASCVD risk and 373 men with moderate-to-high ASCVD risk. Serum osteocalcin levels were lower in the moderate-to-high risk vs. low risk men (p=0.042). Multivariate stepwise regression analysis showed that body mass index (BMI) and glycated hemoglobin were predictors for reduced osteocalcin levels (both p<0.001). Among all subjects, the proportion with an elevated C-IMT was higher in the low-osteocalcin group than in the high-osteocalcin group (p=0.042), and the significance of this result was greater when considering only subjects with a moderate-to-high ASCVD risk (p=0.011). The recognition rate of elevated C-IMT was superior with both low osteocalcin and moderate-to-high ASCVD risk vs. either parameter alone (p<0.001 and p=0.015, respectively). Osteocalcin was independently and inversely associated with elevated C-IMT after adjusting for the 10-year ASCVD risk score (p=0.004). The negative relationship remained statistically significant in subjects with a moderate-to-high ASCVD risk in particular (standardized β=−0.104, p=0.044).In middle-aged and elderly men, serum osteocalcin levels strengthen identifying subclinical atherosclerosis over ASCVD risk score, especially among subjects with a moderate-to-high ASCVD risk.