Objective To explore the relationship between neutrophil/lymphocyte ratio (NLR) and lipoprotein-associated phospholipase A2 (LP-PLA2) and carotid intima-media thickness (CIMT) in elderly patients with type 2 diabetes mellitus (T2DM). Methods A total of 276 T2DM patients were enrolled in this study, who admitted to geriatric and endocrine departments of Taizhou People′s Hospital from January 2018 to January 2020 and were divided into two groups:normal CIMT group (CIMT<1.0 mm, NCIMT, n=138) and abnormal CIMT group (CIMT≥1.0 mm, ACIMT, n=138). Healthy individuals were enrolled as control group (NC, n=135). Clinical biochemical index, blood routine and plasma LP-PLA2 level were measured. SPSS statistics 20.0 was used for data analysis. Depending on different data types, one-way analysis of variance or Kruskal-Wallis H test was used for comparison between groups. Partial correlation was used to analyze the correlation between NLR and LP-PLA2 and each index. Multiple stepwise regression was performed for the risk factors of CIMT in the T2DM patients.Results NLR and LP-PLA2 levels were higher in NCIMT group and ACIMT group than in NC group [NLR:(2.51±0.82) vs (2.78±1.01) vs (2.23±0.77); LP-PLA2:(142.80±37.24) vs (154.78±45.92) vs (130.17±39.37) ng/ml; all P<0.05], and ACIMT group were higher than NCIMT group. Correlation analysis showed that NLR was positively correlated with systolic blood pressure, diastolic blood pressure, fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), and CIMT (P<0.05); LP-PLA2 was positively correlated with total cholesterol, low-density lipoprotein cholesterol (LDL-C), and CIMT (P<0.01); LP-PLA2 was positively correlated with NLR (P<0.01). Multiple stepwise regression analysis showed that the factors affecting CIMT were course of T2DM, FBG, HbA1c, LDL-C, NLR and LP-PLA2 (β=0.009, 0.028, 0.032,0.036,0.069,0.001, respectively; P<0.05 or P<0.01). Conclusion NLR and LP-PLA2 are risk factors of CIMT in elderly T2DM patients, and may be related to the occurrence and development of atherosclerosis in those patients.