Objective: To evaluate the impact of risk factors on atherosclerotic changes of aortic wall and valve in patients with and without non-familial hypercholesterolemia by transthoracic echocardiography. Methods: One hundred and eleven patients with non-familial hypercholesterolemia and 112 control subjects were included in the study. Aortic wall and valve were evaluated by visual assessment of wall hyperechogenicity and measuring the valve thickness. Aortic diameters were obtained at the levels of annulus, sinus of Valsalva and at the supravalvular level in the parasternal long-axis view by M-Mode echocardiographic examination. The relationship between parameters of aortic atherosclerosis and risk factors was studied by multivariate logistic regression analysis, Pearson and Spearman correlation analyses. Results: The prevalence of aortic wall hyperechogenicity was found to be higher in patients with hypercholesterolemia (84.7% vs 70.5%, p=0.01). The mean aortic root diameters at all levels of patients with hypercholesterolemia were found to be significantly smaller than in patients of the control group (3.1±0.3 mm vs 3.2±0.5 mm, p=0.02 for annulus level, 3.4±0.4 mm vs 3.5±0.4, p=0.004 mm for the level of sinus of Valsalva and 3.2±0.3 mm vs 3.4±0.5 mm, p<0.001 – supravalvular level), but no difference was noted regarding the aortic velocity and pressure gradient across the aortic valve. Multivariate stepwise logistic regression analysis showed that age (OR=1.1, CI – 1.02-1.09, p=0.002) and smoking (OR=2.2, CI – 1.06-4.58, p=0.04) were independent predictors of aortic valve thickness. Hypercholesterolemia was an independent predictor for aortic wall hyperechogenicity (OR=2.5, CI – 1.3-4.9, p=0.009) but not for valve thickness. Conclusions: Age, smoking and hypercholesterolemia are related to atherosclerotic involvement of aortic wall and valve.