BACKGROUND: Oxidized low-density lipoprotein (oxLDL) leads to atherosclerosis and cardiovascular disease, the most frequent causes of death worldwide. After menopause, lipid and lipoprotein metabolism changes and women are at greater risk of cardiovascular disease compared to fertile women. The aim of this study was to determine the prevalence of serum oxLDL in postmenopausal women and to identify possible associations of clinical and laboratory features with oxLDL in these patients. METHOD: After clinical examination and completing a clinical questionnaire, an ultrasound examination of both carotid arteries was conducted and blood was drawn from 533 postmenopausal women. oxLDL concentration was determined using proton NMR spectroscopy. RESULTS: Oxidized LDL was detected in 12.4% (95% confidence interval 9.7-15.5) of postmenopausal women with a median of 0.18 mg/dl (interquartile range 0.10-0.43). Although intima-media thickness did not differ, postmenopausal women with serous oxLDL had more often atherosclerotic plaques compared to women without oxLDL (6/66 vs. 0/467; P < 0.01). Higher concentrations of high-density lipoprotein, impaired glucose intolerance, and DBP were independently associated with the occurrence of oxLDL. If oxLDL was present, higher high-density lipoprotein and glucose intolerance were associated with higher concentrations of oxLDL. In contrast, higher blood urea concentrations were associated with lower concentrations of oxLDL. CONCLUSION: This study presents the prevalence and concentration of oxLDL in postmenopausal women and demonstrates that oxLDL concentration can be quantified by proton NMR spectroscopy in large patient samples. The data suggest that oxLDL may be a biomarker for incipient atherosclerotic changes in postmenopausal women. In contrary to the association of dyslipoproteinemia and diabetes, higher blood urea concentrations were associated with lower concentrations of oxLDL.