Background: Many studies have shown an inverse relation between green tea consumption and cardiovascular risk. The aim of this study was to assess the relationship of green tea consumption with common carotid artery intima-media thickness (CCA-IMT) and carotid plaques. METHODS: Subjects were drawn from the Korean Health and Genome Study, which is an ongoing population-based prospective study of Korean adults aged 40 to 69 years. The final sample was 5,453 subjects, comprised 2,730 men and 2,723 women. All participants were reevaluated after an interval of 2 years. Atherosclerotic plaques in the extracranial carotid arteries and CCA-IMT were measured using a standardized protocol. Analyzing carotid IMT result were performed at the University of Pittsburgh. RESULTS: Increasing daily green tea consumption was associated with a lower prevalence of carotid plaques. Carotid plaque frequency was 6.8%, 4.8%, and 4.4% in subjects drinking no tea, 1 to 6 cups/week and more than 3 cups/day (P=0.017). This association was independent of age, sex, smoking, hypertension, diabetes, alcohol and coffee consumption and dietary habits (adjOR=1.5 [95%CI:1.08 to 2.08] for drinking more than 3 cups/day compared with none). Compared with subjects drinking no tea, subject drinking more than 3 cups/day had lower IMT values (0.70 +/- 0.07 mm versus 0.72 +/- 0.08 mm, P < 0.001). CONCLUSIONS: The green tea consumption was inversely associated with carotid plaques and IMT values in a large sample of community subjects in Korea.