To analyze whether atherosclerotic risk factors, including systemic hypertension, an elevated serum cholesterol level, smoking and diabetes, were associated with the presence of aortic stenosis (AS) in adults, 105 adults who had AS without coronary artery disease (CAD) were compared with 110 control subjects who had other types of valvular disease, 170 control subjects who underwent catheterization and had neither valvular disease nor CAD, and 269 matched control subjects who underwent general surgery. When using each control group separately or in combination, no risk factor showed consistent evidence of a significant association with the development of AS. If the true magnitudes of these associations are of the order previously reported for the development of CAD, the power of our study for detecting statistical significance ranges from 56 to 99%. In a supplemental analysis, 45 cases with both AS and CAD did not have a higher prevalence of risk factors than cases without CAD. Although a weak association between atherosclerotic risk factors and AS cannot be excluded, any such association is unlikely to be as strong as for predicting CAD.