Background: Globally, the most prevalent hereditary autoinflammatory illness is Familial Mediterranean fever (FMF).  It results in polyserositis, feverish periods of inflammation, and in rare cases, erysipelas-like erythema or non-erosive monoarthritis. Because of their chronic and recurring inflammatory condition, patients with FMF are at risk for cardiovascular disease. Endothelial dysfunction caused by persistent chronic inflammation is a major factor in the development of atherosclerosis. Objective: To detect early cardiac affection and subclinical atherosclerosis in FMF patients. Patients and Method: This study included 30 children with FMF and 30 apparently healthy children as control group. Patients with thyroid, hepatic, renal diseases, history of heart failure, any valve disorders or ischemic heart disease or any other autoimmune diseases were excluded from the study. Demographic data was collected and clinical disease severity was assessed by FMF severity index. Subclinical atherosclerosis was detected by carotid intima-media thickness (cIMT) and cardiovascular assessment using Echo and ECG was done. Results: cIMT was significantly higher in FMF patients (0.75 ± 0.08 mm) than controls (0.64 ± 0.037) and there was a significant positive correlation between cIMT and duration of the disease, triglycerides, LDL, cholesterol and HDL. Conclusions: FMF patients may be associated with cardiovascular and early subclinical atherosclerosis. Furthermore, cIMT can be regarded a viable noninvasive approach for detecting early atherosclerosis.