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Background and aim Accelerated atherosclerosis is a leading cause of increased cardiovascular morbidity and mortality in patients with systemic lupus erythematosus (SLE). Atherosclerosis is mediated by multifactorial processes including inflammation, endothelial dysfunction, autoantibodies, dyslipidemia, and traditional risk factors. So, we aimed to evaluate carotid intima-media thickness (CIMT) for early detection of subclinical atherosclerosis in patients with SLE and to determine its correlation with disease activity. Patients and methods A total of 50 patients with SLE and 50 healthy controls were included in this study. Full detailed history, clinical examination, and laboratory findings for all the participants were recorded. ECG was done for the patients and controls for the detection of QT dispersion. CIMT was measured bilaterally at the distal common carotid artery. Results On measuring CIMT, we found thickened CIMT (>0.8 mm) in 28% and plaques in 18% of the patients. There was a highly significant increase in the right CIMT, left CIMT, and mean CIMT of both sides in the patients in comparison with the controls (P