Objective：To observe the association of copeptin levels with coronary atherosclerotic lesions in postmenopausal women with impaired glucose tolerance（IGT）. Methods：Eighty postmenopausal women （aged 56-59 y）with the onset of IGT（fasting blood glucose，i.e. FBG＜7.0 mmol/L，7.8 mmol/L≤2-hour postprandial blood glucose，i.e.2hPBG＜11.0 mmol/L）were divided into group A（copeptin < 5 pmol/L）and group B（copeptin > 20 pmol/L），according to serum copeptin levels at baseline，40 cases in each group. The discrepancy of coronary CTA stenosis scores was analyzed between the two groups at baseline and after 6-month follow-up. Results：①At baseline，the difference was statistically significant in copeptin levels（P < 0.05），but not in weight，FBG，2hPBG，fasting serum triglyceride（TG），total serum cholesterol（TC），serum low-density lipoprotein cholesterol（LDL-C），mean arterial pressure，serum creatinine and age between group A and group B（P＞0.05）.②After 6-month therapeutic lifestyle adjustment as well as oral administration of aspirin（100 mg qd）and rosuvastain（10 mg qd），copeptin level，coronary CTA stenosis scores，FBG and 2hPBG of group B was statistically significantly higher，compared with group A，respectively（P < 0.05）.Furthermore，some cases developed diabetes or coronary heart disease（CHD）in group B，while not in group A. Conclusion：On the basis of the influence of the atherosclerotic risk factors of IGT and postmenopausal female，high plasma copeptin level will further promote the occurrence and deterioration of coronary atherosclerotic lesions.