Background: The ideal cardiovascular health (CVH) has been reported to be associated with reduced risk of ischemic stroke (IS). Atherosclerosis is a fundamental precursor in progression to IS. This study aimed to investigate the association of CVH score and atherosclerosis defined by carotid plaque in a community-based cohort. Methods: Data came from the Asymptomatic Polyvascular Abnormalities Community study. After exclusions for missing data and original carotid plaque, 1938 subjects were included. At baseline (2010), the 7 CVH factors were quantified on a 14-point scale with 2 points awarded for ideal status, 1 point for intermediate, and 0 point for poor. The incidence of carotid plaque from 2010 to 2012 was evaluated from bilateral common, internal, and external carotid arteries, and carotid bifurcations using high-resolution B-mode ultrasounds. Multivariable logistic models were used to assess the association between CVH score and carotid plaque incidence. Results: After 2 years' follow-up, 350 (18.06%) subjects developed carotid plaque. After adjusting for age, sex, education, and income, we observed a significant inverse association between the CVH score and incident carotid plaque. For every CVH score increase, the risk of carotid plaque incidence decreased by 8.10%. Stratified analysis showed the above association had no difference between sexes and age. Conclusions: Chinese subjects with a higher CVH score had a lower risk of developing carotid plaque after 2 years. The ideal CVH concept should be further promoted for protecting the arteries from atherosclerosis.