To explore the association of baseline cholesterol level in 1992 and its 10-year change from 1992 to 2002 with the prevalence of carotid atherosclerosis. In 1992, 1985 subjects of the community of Peking University, aged 35 - 64, underwent physical examination and blood-lipid test to study the cardio-vascular disease (CVD) risk factors. In 2002, the second survey on CVD risk factors was conducted among the existing 1932 subjects, now aged 45 - 74. In addition, B-mode ultrasonography of the carotid artery was performed too. The complete data of 1331 subjects were analyzed. (1) In 2002, the prevalence rates of intimal medial thickening (IMT) and carotid plaque in the study population were 47.8% and 29.9% respectively. (2) The post-10-year prevalence rate of carotid plaque was 19.7% in the subjects with the baseline cholesterol < 3.64 mmol/L, and was 46.8% in those with the baseline cholesterol 6.24 mmol/L, with a thickening rate 3.1 times that of the subjects with the baseline cholesterol < 3.64 mmol/L. The higher the baseline TV level, the higher the prevalence rates of carotid plaque and IMT. (3) The prevalence rate of carotid plaque was 32.0% in the subjects with normal TC in both 1992 and 2002, and 50.0% in those with hypercholesterolemia in both 1992 and 2002. Carotid atherosclerosis is a prevalent disorder in the people aged 45 - 74 in Beijing. The prevalence rates of carotid plaque and IMT increase with the elevation of baseline cholesterol level.