It is debatable whether the rate of change in carotid intima‑media thickness (CIMT) may be used as a risk indicator of major adverse cerebral and coronary events (MACCEs) in patients with either coronary (CAD) and peripheral artery disease (PAD). This prospective study aimed to evaluate the association between CIMT changes and the incidence of MACCEs, in patients with symptomatic CAD and PAD. The study comprised 466 patients admitted with steno‑occlusive disease, in whom revascularization was performed for an index lesion. Group 1 included 305 subjects with CAD, and group 2, 161 patients with PAD. CIMT was measured at baseline and at a median of 21 and 41 months afterwards. The incidence of MACCE, cardiovascular death (CVD), myocardial infarction (MI), and ischemic stroke was recorded prospectively during 5 years. CIMT increased with a mean (SD) progression rate of 0.027 (0.16) mm/y in group 1 and 0.026 (0.17) mm/y in group 2 (P = 0.89). CIMT regression was recorded in 112 patients (36.7%) and 61 patients (37.9%) in groups 1 and 2, respectively, at baseline (P = 0.80), and 82 patients (26.9%) and 42 patients (26.1%) in groups 1 and 2, respectively, in follow‑up (P = 0.85). Maintained CIMT regression was independently associated with a reduced risk of MACCEs (hazard ratio [HR], 0.25, 95% CI, 0.15-0.42), MI (HR, 0.32; 95% CI, 0.20-0.51), ischemic stroke (HR, 0.29; 95% CI, 0.18-0.45), and CVD (HR, 0.24; 95% CI, 0.15-0.40), while the CIMT progression rate of 0.056 mm/y was associated with an increased risk of MACCEs (sensitivity, 53.2%; specificity, 72.2%; area under the receiver operating curve, 0.65). Maintained CIMT regression is associated with 68% to 75% reduction in the risk of a cardiovascular event. However, a long‑term maintained CIMT regression is achieved in one‑fourth of patients with either CAD or PAD.