Objective To investigate the relationship between hyperuricemia and carotid artery atherosclerosis in postmenopausal women. Methods A total of 196 consecutive postmenopausal patients with dyslipidemia and receiving carotid artery ultrasonography in First Affiliated Hospital, Dalian Medical University from January to June 2012 were enrolled in this study. Among them, 156 patients were diagnosed with atherosclerosis and carotid atherosclerotic plaque (group A) identified by color Doppler ultrasound examination, and the other 40 cases had no atherosclerosis (group B). The age, blood pressure, body mass index (BMI), blood estradiol (E2), blood glucose, blood lipid and uric acid levels were compared between the two groups. Results There was no significant difference in the age, blood pressure, blood glucose, blood levels of triglycerides and high-density lipoprotein, BMI value and E2 levels between the two groups. However, group A had significantly higher uric acid [(455.32±54.67) vs (374.32±45.76)μmol/L, P＝0.02] and low-density lipoprotein cholesterol (LDL-C) [(4.41±0.84) vs (4.11±0.81)mmol/L, P＝0.04] than group B. Uric acid levels showed positive correlation with triglycerides and LDL-C respectively (r＝0.315, r＝0.214), but negative correlation with high-density lipoprotein cholesterol (HDL-C) (r＝-0.243). Among the 124 patients with hyperuricemia out of group A, they had significantly higher levels of LDL-C [(4.49±0.81) vs (4.26±0.79)mmol/L, P＝0.04] and triglycerides [(2.66±0.34) vs (2.45±0.39)mmol/L, P＝0.02], and significantly lower level of HDL-C [(1.09±0.39) vs (1.21±0.40)mmol/L, P＝0.03] when compared with the patients with normal uric acid level from group A. Conclusion Besides blood lipid, uric acid level is closely related with the carotid atherosclerosis in postmenopausal women.