Background and purpose Extracranial internal carotid artery thromboembolism is one major cause of ischaemic stroke and the predictive value of non‐high‐density lipoprotein cholesterol (non‐HDLC) is superior to low‐density lipoprotein cholesterol (LDLC). This study aimed to assess the association between non‐HDLC levels and the prevalence of asymptomatic extracranial internal carotid artery stenosis (EICAS) as well as the predictive value of non‐HDLC over LDLC on EICAS presence. Methods The Asymptomatic Polyvascular Abnormalities Community study is a subset of the Kailuan study emphasizing asymptomatic polyvascular abnormalities in Chinese adults. A total of 5351 participants, aged ≥40, without history of cardiovascular disease were enrolled in this study. Carotid duplex ultrasonography was carried out for the detection of EICAS. Results Of the 5351 patients, 2.5% (131/5351) were diagnosed with EICAS (stenosis ≥50%). Univariate analysis showed that non‐HDLC is an independent indicator for asymptomatic EICAS [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.17–1.91]; the same result was reached in multivariate analysis after adjustment for confounding factors (OR 1.32, 95% CI 1.00–1.75), especially for people with hypertension (OR 1.52, 95% CI 1.11–2.08), whilst non‐HDLC failed to show better predictive value of EICAS than LDLC (OR 1.45, 95% CI 1.02–2.05). Conclusions Non‐HDLC is an independent risk factor for EICAS prevalence, especially for hypertension patients. Although the predictive value of non‐HDLC was no better than LDLC on EICAS presence, non‐HDLC is still a powerful atherogenic factor and potential therapeutic target for EICAS.

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