Aim To investigate the impact of cardiovascular health behaviors and health factors on the carotid intima-media thickness in middle-aged population. Methods A cross-sectional study method was used in this study. Subjects with myocardial infarction, ischemic stroke(not including lacunar infarction), data incomplete were excluded from the study. The total of 5353 employees (the retired employers from Tangshan Kailuan company) aged 40 years and over were included through stratified random sampling. Information was obtained from the unified questionnaire, measurements of blood biochemistry and carotid ultrasonography. Multivariate linear regression analysis was applied to test the relationship between cardiovascular health score and carotid intima-media thickness. Multivariate logistic regression analysis was applied to analyze the influence of cardiovascular health behavior and factors on carotid atherosclerosis. Results A total of 5353 subjects were included in our study. Their average age was 55.1±11.8 years old (from 40 to 94 years old).Of which, 3209 subjects were male, accounting for 59.5% of the study population. ① The carotid intima-media thickness was 0.89±0.19 mm, 0.88±0.19 mm, 0.85±0.19 mm, 0.82±0.18 mm, 0.80±0.18 mm and 0.76±0.15 mm in the group with less than 2,2, 3,4, 5 and greater than 5 components of ideal cardiovascular health behaviors and health factors,respectively. The incidence of carotid atherosclerosis was 32.6%, 31.4%, 24.7%, 20.3%, 15.9% and 9.5%, respectively. ②Multiple linear regression analysis showed that after adjusting age, sex, TG, HDLC and LDLC cardiovascular health score and carotid intima-media thickness were negatively correlated. The B value of cardiovascular health score was －0.012(95%CI:－0.014～－0.011, P<0.001). Multivariate logistic regression analysis showed that compared with less than 2 components of ideal cardiovascular health behaviors and factors, the detection risk values (OR) of incidence of carotid atherosclerosis in the group with 3,4, 5 and greater than 5 components of ideal cardiovascular health behaviors and factors were 0.2,0.0,0.1,0.18, respectively. Conclusions The ideal cardiovascular health behaviors and factors are protective factors of carotid intima-media thickness in middle-aged population. With the increase of components and scores of ideal cardiovascular health behaviors and factors, both the values of carotid intima-media thickness and the incidence of carotid atherosclerosis decrease.