In the present 2-years prospective study, the diagnostic and prognostic significance of immune cholesterol was assessed in 98 asymptomatic men aged 40-74 with early atherosclerosis. The rate of carotid atherosclerosis progression was estimated by high-resolution B-mode ultrasonography as the increase in carotid intima-media thickness (IMT) of common carotid arteries. The patients with elevated baseline levels of immune cholesterol were characterized by significantly higher levels of total and LDL (low density lipoproteins) cholesterol as well as significantly increased mean IMT of common carotid arteries. Among all baseline lipid parameters, only immune cholesterol and LDL cholesterol were contingent with the extent of early carotid atherosclerosis (p=0.042 and p=0.049, respectively) and had the highest levels of relative risk and odds ratio. Carotid atherosclerosis progression was characterized by slow IMT increase at a rate of 0.029 +/- 0.011 mm per two years over the mean baseline IMT of 0.939 +/- 0.015 mm (p=0.028). A significant IMT increase was registered in 53.1% (n=52) patients, IMT significant reduction was observed in 21.4% (n=21) patients. The increased level of immune cholesterol along with total serum cholesterol and LDL cholesterol had rather high prognostic significance with the respect of atherosclerosis progression. The normal level of immune cholesterol (below than 16.0 mg/ml) was the only lipid parameter that predicted the absence of carotid atherosclerosis progression for two following years at prognostic value of 78.3%. The results of the study allow assuming that immune cholesterol level may be employed not only as a marker of early atherosclerosis, but also has a sufficient prognostic value for clinical implications.