Aim To explore the characteristics of carotid intima-media thickness (IMT) and plaques and their predictive value among patients with premature coronary heart disease (CHD). Methods The clinical profile, angiographic results were studied. IMT and plaques of the common carotid artery were measured by B-mode ultrasound imaging and their predictive value for premature CHD was evaluated. Results Patients with premature CHD had higher average carotid IMT values [(0.79±0.20) mm vs (0.65±0.13) mm, p<0.05]and plaques were more common. Positive carotid artery ultrasound predicted premature CHD with sensitivity of 55.7%, specificity of 88.9% and accuracity of 87.2%. Multivariate Logistic regression revealed that positive carotid artery ultrasound is an independent predictive factor for premature CHD (Or=7.19, 95%CI: 1.92～ 21.37 , P=0.007). Conclusions Patients with premature CHD had higher values of carotid IMT and more carotid plaques. Positive carotid artery ultrasound predicted premature CHD with high specificity and accuracity. Positive carotid findings is an independent predictive factor for premature CHD.