Objective To evaluate whether waist circumference (WC) ≥85 cm is related to asymptomatic preclinical atherosclerosis in women from Shanghai, China. Methods A total of 2365 females aged ≥20 years recruited from 4 communities underwent physical examination and carotid artery scanning. Their carotid intima-media thickness (C-IMT) was measured. Results The C-IMT was significantly higher in overweight or obese women with their BMI ≥25.0 kg/m2 (P<0.01) and in those with their WC ≥85 cm than in those with their WC <85 cm (P<0.01). Spearman and partial correlation analysis showed that the C-IMT was significantly correlated with WC which was independent of menopausal status. The C-IMT significantly increased with the increasing WC and reached to a platform in about 85 cm. An increment tendency was found in the subgroup with its WC < 85 cm (P<0.01) while no significant tendency was found in the subgroup with its WC≥85 cm (P=0.07). Multiple stepwise regression analysis showed that the WC was an independent risk factor for C-IMT. In logistic regression model, the odd ratio of WC ≥80 cm, ≥80 cm and <85 cm and ≥85 cm for evaluating the risk of C-IMT elevation was 1.632, 1.501, and 1.878, respectively. Conclusion WC is significantly correlated with C-IMT in women from Shanghai, China, and WC≥85 cm may be used in identifying the risk of subclinical carotid atherosclerosis.