Aim To investigate the relationship between angiotensin converting enzyme (ACE), apoE gene polymorphisms and the risk of subclinical atherosclerosis (As) in newly diagnosed type 2 diabetes after multifactorial intensified intervention. Methods The DNA polymorphisms in ACE and apoE were determined by PCR-RFLP between 157 newly diagnosed diabetic patients and 93 controls in Han's population of Hunan. Data of body weight, HbA1c, blood pressure, blood lipid and insulin resistance were compared among the groups with different genotypes of ACE and apoE. Characteristics of ACE and apoE gene polymorphisms were compared between patients with and without subclinical As. The association of the risk of subclinical As and apoE, ACE genotypes and their synergistic effects were determined by Logistic regression analysis. Results Frequencies of apoE genotypes in 157 individuals were not different between patients and controls (p>0.05), whereas the frequencies of ACE-I alleles were significantly higher than that in the controls (0.707 vs 0.581, p<0.05). No significant relationship was identified between ACE polymorphisms and blood pressure in this population. ApoE4/X carriers had higher LDLC than that in 2/X carriers (3.19±0.84 mmol/L vs 2.42±0.37 mmol/L, p<0.01). No synergistic effect was found in ACE and apoE geno-type on sBP or LDLC level. There was no association between targeted value of metabolic parameters, arterial intima-medial thickness and the two gene polymorphisms. Meanwhile, no correlation was found between apoE genotypes and the incidence of subclinical As. None of the patients with ACE-DD homozygote suffered from subclinical As, approaching significant difference compared to patients with ACE -II and ID genotype(P=0.059). Conclusions ApoE gene polymorphism may benotapre-dictor, but ACE-DD genotype might be a negative one for the development of subclinical As in patients with newly diagnosed type 2 diabetes after one-year multifactorial intervention.