Background: Epileptic patients are at higher risk for atherosclerosis which may be due to epilepsy itself and/or antiepileptic drugs use (AED). AEDs increase the risk for atherosclerosis through altering the levels of homocysteine, lipid profile and uric acid. Epileptic fits and AEDs provoke the production of inflammatory mediators which participate in atherogenesis and predict future thromboembolic events. Objective: To investigate the relation between chronic epilepsy and epilepsy treatment on atherosclerosis risk. Subjects and Methods: This study was conducted on 40 chronic idiopathic epilepsy subjected to carotid duplex, measurement of CRP and fibrinogen, lipid profile, uric acid and fasting blood sugar (FBS) levels. Results: Levels of high density lipoproteins, high sensitivity C-reactive protein (hs-CRP) and common carotid artery intima media thickness (CCA-IMT) were statistically significantly higher in patients than control. The CCA-IMT was statistically significantly higher in patients with very frequent fits in comparison to patients with less frequent fits. There was significant positive correlation between hs- CRP, fibrinogen levels and CCA-IMT. Hs-CRP was statistically significantly higher in patients on phenytoin in comparison to those on carbamazepine and valproate ,besides LDL levels were statistically significantly higher in patients on polytherapy in comparison to those on monotherapy , there was also significant positive correlation between carbamazepine dose and triglyceride levels as well as significant positive correlation between valproate dose and hs- CRP. Conclusion : CCA-IMT and inflammatory mediators (hs- CRP & fibrinogen) were significantly higher in epileptic patients making them more prone to atherosclerosis and subsequent thromboembolic events also first generation antiepileptic drugs exerts effects on risk factors for atherosclerosis.