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Background: Xanthelasma palpebrarum (XP) is a common cutaneous xanthoma often associated with dyslipidemia. Carotid intima-media thickness (CIMT) is a non-invasive method of monitoring subclinical atherosclerotic plaque formation and its progression. This study was conducted to assess the cardiovascular comorbidities in patients with XP by measuring the CIMT and serum lipid profile. Materials and Methods: A total of eighty patients aged between 18 and 80 years diagnosed clinically with XP and the same number of apparently healthy, age- and sex-matched controls were included in the study after giving informed consent. Detailed history taking, examinations, and investigations were performed for all patients. Results: Significantly raised triglycerides and LDL levels were seen in 56.3% and 66.3% of the cases, respectively. HDL levels were elevated in 63.8% of the cases and 95% of the controls, which was statistically significant. The mean levels of total cholesterol, triglyceride, LDL, and HDL were 169.68 ± 39.91 mg/dL, 159.68 ± 28.61 mg/dL, 121.23 ± 30.13 mg/dL, and 43.09 ± 8.76 mg/dL, respectively. Elevated CCAIMT and ICAIMT were seen in 87.4% and 72.8% of the cases, respectively, which was significant. Conclusions: There was a significant elevation of triglyceride and LDL and a decrease in HDL among the patients with XP when compared to the controls, thus making lipid profile testing compulsory for all patients with xanthelasma. They also have an increased risk of subclinical atherosclerosis, as assessed by the significantly higher values of CCAIMT and ICAIMT. Hence, all xanthelasma patients should undergo CIMT as a screening procedure for the early detection and primary prevention of cardiovascular complications. [ABSTRACT FROM AUTHOR]