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We examined whether HbA1c is associated with carotid atherosclerosis in a community-dwelling elderly Korean population with normal fasting glucose.Using data from the Korean Urban Rural Elderly study, we conducted a cross-sectional analysis in 1,133 participants (335 men and 798 women) with mean age 71.8 years. All participants had fasting blood glucose less than 100 mg/dL (5.6mmol/L) and a level of HbA1c below 6.5% (48 mmol/mol). They were also free from history of cardiovascular disease, known diabetes or use of anti-diabetes medication. Carotid atherosclerosis was assessed by intima-media thickness (IMT) and the number of plaques using ultrasonography. The relationships of HbA1c with carotid IMT and plaque were investigated by multiple linear regression analysis.HbA1c levels are independently and positively associated with carotid IMT (standardized β=0.06, p = 0.042) and number of plaques (standardized β=0.06, p = 0.021) after adjustment for sex, age, body mass index, systolic blood pressure, diastolic blood pressure, triglyceride, LDL cholesterol, smoking and alcohol intake, particularly in men. However, fasting insulin and glucose levels were not associated with carotid IMT or plaques.HbA1c levels are positively associated with carotid atherosclerosis measured by carotid IMT and plaques in an elderly population with normoglycemia. Our study suggested that higher HbA1c level may contribute to carotid atherosclerosis among older adults with normal fasting glucose.