The aim of this study was to examine the applicability of echo tracking to evaluation of common carotid artery wall elasticity in smokers and the effects of hypertension, hyperlipidemia and hyperglycemia on common carotid artery wall elasticity in smokers. Subjects were divided into three groups based on smoking status and presence of complications: group A (healthy control group), group B1 (simple smoking group) and group B2 (smoking with complications group). Complications included one or several symptoms of hypertension, hyperlipidemia and hyperglycemia. Intima-media thickness (IMT) of the common carotid artery was measured with ultrasound, and wall stiffness index(beta), pressure-strain elasticity modulus (E-p), arterial compliance, augmentation index and local pulse wave velocity (PWV beta) were measured with echo tracking. We also determined the systolic (D-s) and diastolic (D-d) lumen diameters of the common carotid artery and systolic (P-s) and diastolic (P-d) pressures. The differences in beta, E-p and PWV beta among the three groups in this study were statistically significant (p < 0.05). Augmentation index was increased in group B2 compared with groups B1 and A, with the differences being statistically significant (p < 0.05). Differences in augmentation index between groups B1 and A, differences in arterial compliance among the three groups and differences in intima-media thickness among the three groups were not statistically significant (p > 0.05), but differences in D-s and D-d among the three groups were statistically significant (p < 0.05). Differences in P-s and P-d between groups A and B1 were not statistically significant (p > 0.05), whereas those between groups B1 and B2 were statistically significant (p < 0.05). Echo tracking can be used to quantitatively evaluate the effect of smoking on common carotid artery wall elasticity and the effects of hypertension, hyperlipidemia and hyperglycemia on common carotid artery wall elasticity in smokers. Published by Elsevier Inc. on behalf of World Federation for Ultrasound in Medicine & Biology.