Background: Elastic property of artery is known to be a new determinant of cardiovascular risk. However, limited evidence exists on whether non-invasively measured carotid arterial distensibility relates to the presence and degree of angiographically-confirmed coronary artery stenosis. We aimed to investigate the relationship between carotid distensibility (CaD) and coronary artery disease (CAD) in angina patients. Methods: We enrolled a total of 70 patients with angina admitted to our institute for coronary angiography (from Jun 1, 2011 until Sep 5, 2011). Patients with acute myocardial infarction, significant aortic valvular disease, or aortic aneurysm were excluded. Carotid images were acquired using an iE33 (Philips Medical Systems, Andover, MA). To measure carotid cross-sectional area, semi-automated software (QLab, Philips) was used to identify the blood-endothelial interface. CaD was calculated from distensibility coefficiency (DC) = (change in area) /[(end-diastolic area) x (change in blood pressure)]. Patients were divided into three groups based on the angiographic findings: non-significant disease (luminal narrowing <50%, Minimal CAD); single-vessel (1VD); and two- or three-vessel disease (MVD) with luminal narrowing >50%. Results: For baseline characteristics, there were no significant differences in age, sex, systolic or diastolic blood pressure, pulse pressure, body mass index (BMI), highly sensitive C-reactive protein, triglyceride, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol levels between three groups. However, The prevalence of Diabetes mellitus (DM) was associated with CAD presence and severity in each Minimal CAD, 1VD and MVD group (0 % vs. 25 % vs. 37 %, p=0.02). DC showed statistical difference according to CAD presence (15.5짹 8.3 vs. 11.2짹 6.3, P=0.021), but showed no significant difference according to CAD severity in these three groups (15.5짹 8.3 vs. 9.4짹 5.6 vs. 14.6짹 8.9 10-3/kPa, p=0.051). Conclusion: Carotid mechanical property measured non-invasively from DC predict the presence of coronary atherosclerosis. Arterial stiffness assessed using ultrasonic imaging thus can be considered as a useful non-invasive marker of the presence of coronary atherosclerosis, providing the clinicians with information on the need to proceed to further invasive angiography in angina patients.