Objective To investigate the relationship between the bilirubin level in serum and carotidatherosclerotic plaque.Methods We selected 475 subjects of Kaluan Group who had received a physical examinationin the period from September to October in 2009. The subjects were divided into two groupsaccording to carotid artery plague examined with colour doppler ultrasonography(111 cases ofcarotid atherosclerotic plaque group and 364 cases of control group) and were divided into fourgroups according to the level of total bilirubin.Results ①There was significant difference(P <0.05) in group of carotid atheroscleroticplaque(12.61±5.17 μmol/L) compared to in control group(13.83±5.31 μmol/L). ②There wasno significant difference(P =0.067) in different serum bilirubin levels. However, the formationrate of carotid atherosclerotic plague showed decrease trend with the serum bilirubin levelincreased. ③Higher serum bilirubin level is one of the protective factors for carotid atheroscleroticplaque(OR 0.43; 95%CI 0.23~0.81). ④correcting other affected factors, higher serum bilirubinlevel still is a protective factor for carotid atherosclerotic plaque.Conclusion There was some relationship between serum bilirubin and carotid atheroscleroticplaque. Higher serum bilirubin level had certain protective effects on artery atherosclerotic plaque.