Aim To investigate the role of postprandial triglyceride levels in atherosclerosis, we examined the correlation between postprandial triglyceride levels and the carotid and femoral arteries atherosclerosis in elderly patients with coronary heart disease (CHD). Methods Carotid intima-media thickness (IMT) and plaque in the carotid and femoral arteries were measured by ultrasonography in 47 elderly patients with CHD and 30 controls. Plasma triglyceride(TG),total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, Apo A, Apo B levels were measured after overnight fasting and 4 h after a meal. Results The fasting cholesterol and Apo B were significantly higher in CHD group than those of the control group (p<0.05). The postprandial triglyceride and low density lipoprotein cholesterol were significantly higher and the postprandial high density lipoprotein cholesterol was significantly lower in CHD group than those of the control group (p<0.05). The IMT of common carotid arteries and the plaque index of carotid and femoral arteries in CHD group were significantly higher than those of the control group (p<0.01). Common carotid IMT was significantly increased in CHD group compared with the control group. Postprandial triglyceride levels were correlated with fasting triglyceride levels. Fasting total cholesterol was correlated with the plaque index of carotid. Conclusion Postprandial hypertriglyceride despite normal fasting triglycerid levels may be an risk factor for atherosclerosis in elderly patient.