OBJECTIVE To investigate the association of carotid arterial intima-media thickness (IMT) with principal cardiovascular risk factors in the elderly. METHODS Carotid arterial IMT was measured by high resolution B mode ultrasound in 94 elderly subjects (old-aged group), and compared with subjects aged < 60 (middle-aged group). RESULTS In comparison with the middle-aged group, the prevalence of coronary heart disease, cerebral vascular disease, hypertension and diabetes mellitus was significantly higher, and serum cholesterol and systolic blood pressure were also significantly higher in old-aged group. Although there was no obvious difference in IMT between the two groups, carotid plaque and carotid wall thickening were more frequently found in old-aged group. Age, systolic blood pressure and serum cholesterol were shown as the independent determinants for carotid IMT in the total participants, whereas no such independent relation was found in old-aged group. CONCLUSIONS Age is the major risk factor for carotid atherosclerosis in the elderly. In other words, the occurrence of carotid atherosclerosis is the result of advancing age combined with the effect of multiple cardiovascular risk factors.