Background: Inflammatory bowel disease (IBD) is a chronic intestinal disease that can be caused by a variety of environmental and genetic factors. Several processes that are chronically stimulated in IBD patients have been involved in the pathophysiology of atherosclerotic cardiovascular disease (ASCVD). Objective: We aimed to estimate 10 years of risk ASCVD in patients with IBD, and to clarify the importance of laboratory and non-invasive imaging modalities in early detection and estimation of ASCVD risk in those populations. Patients and methods: This was a cross-sectional observational study that was conducted on 80 candidates between October 2019 and October 2021, forty of them were IBD patients and forty were healthy volunteers. Patients were diagnosed as IBD by clinical picture, multi-slice spiral computed tomography (MSCT) abdomen, and colonoscopy followed by histopathological study of the biopsies according to ECCO consensus criteria. For the control group, 40 healthy volunteers were matched by gender and age without other known risk factors for atherosclerosis. Results: 25 patients were diagnosed as ulcerative colitis, while 15 were diagnosed as Crohn's Disease. IBD patients showed significant dyslipidemia. The median and range of estimated ASCVD risk % among the patients were 27.0 (0.3-46.0), while for the control group, 7.0 (0.3-46.0), and P-value was 0.001. IBD patients had significantly higher pericardial fat in comparison with healthy controls (2.15 (0.04-4.80) vs 1.43 (0.04-3.20), P-value was 0.027*). Multivariate regression analysis showed that increased both pericardial fat; carotid intima-media thickness (CIMT); hyperlipidemia and disease activity were predictors for subclinical ASCVD in patients with IBD. Conclusions: The risk of ASCVD is risen in IBD patients, particularly during active disease, with increased carotid intimal thickness and wall stiffness. Estimating the thickness of epicardial adipose tissue (EAT) and CIMT were significant predictors.