In a community-based study of 1295 Chinese men and women free of myocardial infarction and stroke we found that interleukin-10 (IL-10) −592C/C genotype was significantly associated with decreased risk of early carotid atherosclerosis compared to −592 A/A genotype. This observed association was significantly modified by known atherogenic risk factors namely smoking and obesity. In people with normal cholesterol (< 200 mg/L), −592 C/C genotype was also associated with lower levels of highly-sensitive C-reactive protein. Our findings generate an interesting hypothesis that the IL-10 −592C/C genotype may exert its protection against early atherosclerosis through anti-inflammatory pathways. Our results also confirm that gene–risk factor interaction plays an important role in pathogenesis of early atherosclerosis.