Background: Smoking has been found to be associated with carotid atherosclerotic disease. Since smoking is an important public health problem, because it may be an essential risk factor for carotid artery plaques. Therefore the researchers tried to explore the powerful of this association, the researchers investigated smokers as unique suspected risk factor for carotid plaques beside the age. Methods: In observational cross-sectional study, 31 smokers with mean age of 56, were studied by B- mode ultrasound. Carotid arteries for all participants were examined by using 7MHrz linear transducer. Both saggital and transverse views were applied to evaluate the right and left common carotid arteries. Results: The frequency of carotid plaque was 35.5%. 54.5 % of these occurred in population group that smoke > 20 cigarettes per day. All plaques were presented in population of age above 53 years old. There was association between smoking frequency and age with the increases of plaque size. Conclusion and recommendations: The study suggested that there is a significant association between carotid plaques and smoking in Saudi smokers. In addition it showed that carotid plaque may present at age of 54 years old in smokers. The researchers recommended that further studies were needed. Moreover intensive health promotion against smoking in the KSA. represents an essential issue.