Objective To investigate the relationship between serum forkhead box F1(FOXF1)and Ape-lin-13 levels and carotid atherosclerosis(CAS)in elderly patients with type 2 diabetes mellitus(T2DM).Methods From January 2022 to March 2024,207 elderly T2DM patients admitted to the hospital(T2DM group)and 52 healthy elderly patients underwent physical examination(control group)were selected as the study objects.The elderly T2DM patients were divided into CAS group(128 cases)and non-CAS group(79 cases)according to the occurrence of CAS.Serum FOXF1 and Apelin-13 levels were detected by real-time flu-orescent quantitative PCR and enzyme-linked immunoadsorption assay.The influencing factors of CAS in eld-erly T2DM patients were determined by multivariate unconditional Logistic regression,and the predictive effi-cacy of serum FOXF1 and Apelin-13 levels was analyzed by receiver operating characteristic curve.Results The levels of FOXF1 and Apelin-13 in T2DM group were lower than those in control group(P＜0.05).The inci-dence of CAS in 207 elderly T2DM patients was 61.84％(128/207).The levels of serum FOXF1 and Apelin-13 in CAS group were lower than those in non-CAS group(P＜0.05).The independent risk factors of CAS in elderly T2DM patients were the duration of T2DM,glycosylated hemoglobin and low density lipoprotein cho-lesterol(P＜0.05),and the independent protective factors were FOXF1 and Apelin-13(P＜0.05).The com-bined prediction of serum FOXF1 and Apelin-13 levels for CAS in elderly T2DM patients was 0.882,which was larger than 0.782 and 0.791 predicted by serum FOXF1 and Apelin-13 levels alone(P＜0.05).Conclu-sion The decrease of serum FOXF1 and Apelin-13 levels in elderly T2DM patients is closely related to CAS,and the combined detection of serum FOXF1 and Apelin-13 levels has a high predictive effect on CAS in elder-ly T2DM patients.