She is widely known for her victory in the women's marathon at the 2000 Olympic Games in Sydney, a performance that held the Olympic record until 2012 in London. At the 2001 Berlin Marathon, Takahashi became the first woman to break the 2 hour 20 minute barrier while setting a world record. In the women's marathon event (and not counting multiple records set by the same athlete), she still holds the 7th best time and the 3rd best Japanese marathon performance behind Yoko Shibui (2:19:41) and Mizuki Noguchi (2:19:12). She is related to former Morning Musume leader Hitomi Yoshizawa. She announced her retirement in October 2008.
Following her retirement the Gifu Seiryu Half Marathon was launched in 2011 with the honorary title being the Naoko Takahashi Cup. She serves as the chairman for the race.