Carotenoids are pigments found in fruits and vegetables. While high intakes of fruits and vegetables have been found to be associated with lower mortality, our objective is to investigate if total plasma carotenoids, via their antioxidant properties, are associated with mortality risk in a free-living elderly population. The 'Epidemiology of Vascular Ageing' (EVA) study (n 1389; 59-71 years) is a 9-year longitudinal study with six waves of follow-up. The association between baseline total plasma carotenoids and mortality was determined by Cox proportional hazards regression analyses. Low total plasma carotenoid level was significantly associated with all-cause mortality in men but not in women. After controlling for potential confounding factors, mortality risk increased significantly in men (P = 0.03) with plasma carotenoids in the lowest quintile compared with men with plasma carotenoids in the highest (relative risk 2.94 (95% CI 1.21, 7.17)). A significant association between mortality by cancer and low plasma carotenoid level variable was also found in men (unit = 1 micromol/l; relative risk 1.72 (95% CI 1.02, 2.86); P = 0.01). Associations between total plasma carotenoids and mortality risk remained statistically significant after taking into account: (1) plasma Se level, which previously was found associated with mortality in this population and (2) thiobarbituric acid-reactive substances level considered as an indicator of oxidative stress. By showing, prospectively, in a general healthy elderly population, that total plasma carotenoid levels were independently associated with mortality risk in men, the present study suggests that total plasma carotenoid levels could be a health indicator in elderly populations.