Diabetic retinopathy (DR) is suggested to be associated with cardiovascular disease (CVD) risk in patients with diabetes. Carotid intima-media thickness (CIMT), as a marker for atherosclerosis presence and progression, is considered useful for evaluating the risk and incidence of CVD. Objectives: To evaluate CIMT in patients with DR who have no reported CVD to detect the association between DR and subclinical atherosclerosis. Methods: A cross-sectional study was done on fifty Egyptian middle-aged adults diagnosed with diabetes. All participants were subjected to history, clinical examination, laboratory tests, comprehensive eye examination, electrocardiogram (ECG), echocardiography, duplex study to measure Ankle/brachial index (ABI), and CIMT. Results: Among the fifty patients with diabetes, thirty-one subjects (62%) had retinopathy. The retinopathy group had significantly higher CIMT than the non-retinopathy group (0.92 ±0.15 mm, 0.79 ±0.12 mm) respectively, (p-value =0.002). Conclusion: DR is associated with increased CIMT and subclinical atherosclerosis.