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Background Triglyceride-glucose (TyG) index is a relatively good predictor of insulin resistance, an indicator that is associated with atherosclerosis. There are few studies on the correlation between TyG index and symptomatic coronary artery disease (CAD) . And there is no evidence definitely determining the relationship between TyG index and carotid atherosclerosis in the elderly. Objective To perform an analysis of the relationship of TyG index with coronary and carotid atherosclerosis, to assess its predictive value for large artery atherosclerosis. Methods A single-center retrospective design was used. Inpatients with suspected CAD in Lanzhou University Second Hospital were enrolled from January 2018 to January 2021. General clinical characteristics, carotid ultrasonography and coronary angiography results obtained from the electronic hospital information system, as well as calculated TyG index, Framingham Risk score, and Gensini score were collected. Results A total of 1 232 cases were enrolled. Correlation analysis showed that the Framingham Risk score, risk of CAD, obstructive CAD, and Gensini score increased with the growth of TyG index value (P<0.01) either in high TyG index (mean value≥9.05, n=616) or low TyG index (mean value <9.05, n=616) group of patients, but had no association with carotid atherosclerosis, mean intimal media thickness (IMT) and carotid plaque score (cPS) (P>0.05) ; CAD and obstructive CAD were positively correlated with carotid atherosclerosis, mean IMT, cPS and Framingham risk score (P<0.001) . Binary Logistic regression analysis showed that high TyG index was associated with increased risk of CAD〔OR=1.385, 95%CI (1.123, 1.707) , P<0.01〕 and obstructive CAD〔OR=1.255, 95%CI (1.034, 1.523) , P<0.05〕. Conclusion TyG index was correlated with coronary atherosclerosis, and its increase was associated with enhanced risk of CAD and obstructive CAD, but had no correlation with carotid atherosclerosis. The relationship between TyG index and carotid atherosclerosis still needs to be confirmed by prospective studies.