BACKGROUND.: To assess markers of vascular dysfunction and risk in postpartum women with a history of severe preeclampsia. METHODS.: Carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) measured by ultrasonography, and lipid profile and insulin resistance evaluated by biochemical assays were compared between 34 women with a history of severe preeclampsia and 42 women with a prior normal pregnancy at least 12–24 months postpartum. RESULTS.: CIMT was higher and FMD lower in the preeclamptic than in the control group. We found a significant inverse correlation between CIMT and FMD in the preeclamptic group, but no difference in lipid profiles and insulin resistance between the groups. CONCLUSIONS.: Women with a history of severe preeclampsia exhibit early structural and functional preatherosclerotic vascular impairment, which might explain their higher risk of future cardiovascular disease. © Wiley Periodicals, Inc. J Clin Ultrasound, 2013