【Abstract】Objective To investigate the relationship between resting heart rate (RHR) and maximal oxygen uptake (VO2max) and carotid intimamedia thickness in middleaged men. Methods The clinical data of 506 middleaged men came to our hospital for medical examination from March 2014 to March 2019 were collected. The patients were divided into 4 levels (＜60bpm, 6069bpm, 7079bpm, ≥80bpm) according to the resting heart rate. The patients were divided into low (≤333%), medium (＞333%, ≤66%) and high (＞666%) 3 levels for analysis according to the maximum oxygen uptake. RHR was measured using a standard 12lead automatic heart transducer, VO2max was determined using an automated respiratory gas analysis system, and carotid intimamedia thickness was measured using a color Doppler ultrasound system. Results The VO2max of patients with RHR≥80bpm was significantly lower than that of patients with RHR＜60bpm (P＜005). Systolic blood pressure, diastolic blood pressure, TG and FBG were significantly higher in patients with RHR≥80bpm than those with RHR＜60bpm (P＜005). There was no significant difference in carotid intimamedia thickness (CIMT) between patients with different RHR (P＞005). Patients with high VO2max had significantly lower RHR, TG, FBG, and ALT with lower VO2max (P＜005). Patients with moderate to high VO2max had significantly lower γGTP and CIMT lower VO2max (P＜005). There was a significant positive correlation between RHR and systolic blood pressure, diastolic blood pressure, TG, FBG and γGTP (P＜005). There was a significant negative correlation between VO2max and BMI systolic blood pressure, diastolic blood pressure, TChol, TG, LDLC, FBG, ALT, γGTP and CIMT (P＜005). The relative risk of carotid atherosclerosis in patients with low VO2max was 3.564 times higher than the patients with high VO2max (95% CI: 17737166). Conclusion VO2max was significantly negatively correlated with BMI, systolic blood pressure, diastolic blood pressure, TChol, TG, LDLC, FBG, ALT, γGTP, and CIMT. In addition, VO2max was an important indicator for predicting the risk of carotid atherosclerosis.