Aim To evaluate the predictive value of carotid atherosclerosis(CAS) in coronary heart disease(CHD). Methods Carotid ultrasound was performed in 191 CHD patients and 175 normal controls. These patients are divided into4 groups according to the results of angiography. Then intimia-media thickness(IMT) and the degree of carotid atherosclerosis were compared in 4 groups. According to the degree of carotid atherosclerosis, the presence of coronary heart disease will be predicted. Results We found that there were significant differences in intimia-media thickness and prevalence rate of atherosclerotic and narrowness rate of carotid artery between control group and the coronary heart disease groups (p<0.05). The more serious the coronary artery disease, the higher incidence rate of carotid artery atherosclerosis. The positive predictive value of carotid plaque score>1, 2, 3 was 68.5%, 73.2%, 74.6%. Conclusion The carotid atherosclerosis is regarded as a better predicative marker for coronary heart disease. Its extent may reflect directly the occurrence, severity and extent of coronary heart disease.