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<p><strong>Objective</strong> To investigate the relation between the level of serum γ-glutamyltransferase (GGT) and the stability of carotid atherosclerotic plaque.  <strong>Methods</strong> A total of 1032 patients with carotid atherosclerotic plaques were divided into stable plaque group (N = 511) and unstable plaque group (N = 521) according to the results of carotid artery Doppler ultrasound examination. Risk factors for unstable carotid plaques were screened by univariate and multivariate forward Logistic regression analysis.  <strong>Results</strong> Compared with patients with stable plaques, percentage of males (<em>P</em> = 0.000), proportion of smoking history (<em>P</em> = 0.000), the serum levels of triglyceride (TG, <em>P </em>= 0.002), low-density lipoprotein cholesterol (LDL-C, <em>P</em> = 0.008) and GGT (<em>P</em> = 0.000) increased significantly, while age (<em>P</em> = 0.000) and serum high-density lipoprotein cholesterol level (HDL-C, <em>P</em> = 0.032) decreased significantly in patients with unstable plaques. Univariate and multivariate forward Logistic regression analysis showed that sex (<em>OR</em> = 1.516, 95%CI: 1.170-1.964; <em>P</em> = 0.002), smoking history (<em>OR</em> = 1.447, 95% CI: 1.085-1.930; <em>P</em> = 0.012), serum TG (<em>OR</em> = 1.127, 95% CI: 1.032-1.231; <em>P</em> = 0.008), serum LDL-C (<em>OR</em> = 1.235, 95%CI: 1.069-1.426; <em>P</em> = 0.004) and serum GGT (<em>OR</em> = 1.012, 95%CI: 1.006-1.019; <em>P</em> = 0.000) were independent risk factors for the occurrence of unstable carotid plaques. <strong> Conclusions</strong> Elevation of serum GGT level is a risk factor for unstable carotid plaques.</p><p> </p><p><strong>DOI: </strong>10.3969/j.issn.1672-6731.2016.03.011</p>