Background: We investigate whether non-high-density lipoprotein cholesterol (non-HDL-C) provides a better estimate of cardiovascular risk than other lipid profiles in normotensive and euglycemic middle-aged and elderly adults. Methods: A total of 512 males and 958 females were enrolled from the Changfeng Study. A standard interview, anthropometric measurements and laboratory analyses were performed for each participant. Bilateral carotid intimamedia thicknesses (CIMTs) were measured using ultrasonography, and the presence of carotid plaques was assessed. Results: The mean values of non-HDL-C were 3.4 +/- 0.8 mmol/l and 3.6 +/- 0.9 mmol/l for male and female subjects, respectively. Compared with female subjects with non-HDL-C in the first quartile, female subjects with non-HDL-C in the fourth quartile had 1.317-fold increased risks for carotid plaques after adjusting for conventional cardiovascular disease (CVD) risk factors and increasing quartiles of all lipid levels. Non-HDL-C was positively associated with the CIMT after adjusting for CVD risk factors in female subjects (beta = 0.062, P = 0.034). Conclusions: These results suggest that non-HDL-C is independently associated with carotid atherosclerosis in normotensive and euglycemic females.