Subclinical atherosclerosis precedes overt cardiovascular disease and can be detected through surrogate markers such as arterial stiffness (AS) and carotid intima-media thickness (CIMT). This review examines the diagnostic and prognostic roles of AS and CIMT, highlighting their potential to improve cardiovascular risk stratification. Although traditional risk prediction models remain the cornerstone of primary prevention, they often fail to identify individuals at risk who lack conventional risk factors. Emerging evidence suggests that integrating CIMT and AS into risk assessment may improve the reclassification of individuals with intermediate risk. However, their routine use remains controversial due to methodological heterogeneity, variability in predictive value, and the prioritization of alternative imaging biomarkers such as carotid plaque or coronary artery calcium (CAC). This article critically assesses the strengths and limitations of AS and CIMT, discussing their potential utility as biomarkers, explores their application into clinical practice, and comprehensively summarizes the latest research.