Abstract: Objective To investigate the correlation between ALDH2 polymorphisms and atherosclerosis in elderly patients. Methods From March to September in 2015, 224 hospitalized elderly patients (＞ 70 years) were assessed in Chinese PLA General Hospital, the patients were divided into two groups according to their ALDH2 genotypes: wild genotype group (GG, n=136) and mutant genotypes group (GA or AA, n=88). The baseline data, carotid ultrasound (including carotid artery intima-media thickness and Crouse score), ankle brachial index (ABI) and baPWV were measured. Results The Crouse score, ABI and baPWV (2.11±1.80) vs (3.45±1.52), (1.13±0.24) vs (0.89±0.21), (1 390.63±92.37) vs (1 677.12±89.54) of mutant genotypes group were higher than wild genotype with statistically significant differences between two groups (P＜ 0.05). Conclusion ALDH2 genotypes are closely related to atherosclerosis, and the mutant genotype of ALDH2 is a risk factor of atherosclerosis.