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Objective: Controversies concerning the association of retinal microvascular abnormalities (RMAs) with atherosclerosis in patients with diabetes exist. The objective of this study was to investigate the association between RMAs and carotid atherosclerotic lesions in Chinese inpatients with type 2 diabetes. Methods: This cross-sectional study involved 2870 type 2 diabetic patients including 1602 men aged 15– 90 years and 1268 women aged 17–88 years. Both retinal arteriosclerosis (RA) and diabetic retinopathy (DR) were determined by digital fundus photography using a standardized protocol. RMAs are defined as the presence of either RA or DR. Carotid atherosclerotic lesions including carotid intima-media thickness (CIMT), carotid atherosclerotic plaque and stenosis were assessed and compared between patients with and without RMAs based on Doppler ultrasound. The association of RMAs with carotid atherosclerotic lesions was analyzed by linear and binary logistic regression analyses. Results: The CIMT values in both male and female diabetics with RMAs were significantly greater than in those without RMAs after controlling for age (0.88 ± 0.21 vs. 0.77 ± 0.20 mmfor men, p = 0.002; and 0.84 ± 0.19 vs. 0.76 ± 0.21 mm for women, p = 0.002). The prevalence of carotid plaque was also markedly higher in patients withRMAs than in thosewithoutRMAs after adjusting for age (54.3% vs. 23.9% formen, p b 0.001; 48.4% vs. 32.0% for women, p = 0.046). However, no significant difference was observed in the prevalence of carotid stenosis in eithermen orwomen with orwithout RMAs. After controlling formultiple confounding factors,RMAs were independently associatedwith increased CIMT in both men (β: 0.067,95% CI: 0.026–0.269, p = 0.018) and women (β: 0.087, 95% CI: 0.058–0.334, p = 0.005) with type 2 diabetes, and they were also closely associated with the presence of carotid plaque (OR: 2.17, 95% CI: 1.54–3.05, p b 0.001 for men; OR: 1.38, 95% CI: 0.91–2.08, p = 0.129 for women) in men with type 2 diabetes. Conclusions: RMAs were closely associated with early carotid atherosclerotic lesions in hospitalized Chinese patients with type 2 diabetes. Our results suggested that changes in retinal microvasculature may play a role in the pathogenesis of atherosclerosis andmay be used as an indicator of early atherosclerosis in patientswith type 2 diabetes. [ABSTRACT FROM AUTHOR]