['Measurements of plaque echogenicity, the gray-scale median (GSM), were shown to correlate inversely with risk factors for cerebro-cardiovascular disease (CVD). The eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio is a potential predictor of CVD risk. In the present study, we assessed the usefulness of carotid plaque GSM values and EPA/AA ratios in atherosclerotic diabetics.', 'A total of 84 type\xa02 diabetics with carotid artery plaques were enrolled. On admission, platelet aggregation and lipid profiles, including EPA and AA, were examined. Using ultrasound, mean intima media thickness and plaque score were measured in carotid arteries. Plaque echogenicity was evaluated using computer-assisted quantification of GSM. The patients were then further observed for approximately 3\xa0years.', 'Gray-scale median was found to be a good marker of CVD events. On multivariate logistic regression analysis, GSM <32 and plaque score ≥5 were significantly associated with past history and onset of CVD during the follow-up period, the odds ratios being 7.730 (P\xa0=\xa00.014) and 4.601 (P\xa0=\xa00.046), respectively. EPA/AA showed a significant correlation with GSM (P\xa0=\xa00.012) and high-density lipoprotein cholesterol (P\xa0=\xa00.039), and an inverse correlation with platelet aggregation (P\xa0=\xa00.046) and triglyceride (P\xa0=\xa00.020). Although most patients with CVD had both low GSM and low EPA/AA values, an association of EPA/AA with CVD events could not be statistically confirmed.'] Is ultrasound analysis of gray-scale median value of carotid plaques a useful reference index for cerebro-cardiovascular events in patients with type 2 diabetes?