An increased iron store has been linked to the risk of atherosclerosis. The carotid intima-media thickness (IMT), stiffness index, Young's elastic modulus (YEM), and augmentation index were determined in 20 patients with beta-thalassaemia major. Compared with controls, patients had greater IMT (P < 0.001), YEM (P = 0.005), and stiffness (P = 0.009) and augmentation (P = 0.03) indices. The odds ratio for increased IMT in patients was 39. Carotid IMT correlated with YEM (P = 0.036), stiffness index (P = 0.036) and augmentation index (P = 0.006). Multivariate analysis identified patient status (P < 0.001) as the only significant determinant of IMT. These findings suggest the possibility of premature atherosclerosis in beta-thalassaemia major patients.