Background: Asthma is associated with an increased cardiovascular disease (CVD) risk in adults, but this risk in children has not been evaluated. We hypothesized that children with asthma and atopy would have early carotid arterial injury.Methods: The Childhood Origins of Asthma (COAST) study is a longitudinal birth cohort of 282 children at increased risk of developing asthma. Children without diabetes mellitus underwent ultrasonography to measure far wall right carotid bifurcation (RCB) and common carotid (RCCA) intima-media thickness (IMT; a measure of arterial injury). Multivariable linear regression models adjusted for age, sex, race, blood pressure, and body-mass index were used to assess associations of asthma and markers of arterial injury.Results: The 89 participants were a mean (standard deviation) 15.3 (0.8) years old and 41% were female. The 26 asthmatics with atopic disease (AA), 36 asthmatics without atopic disease (AA) and 15 non-asthmatics with atopic disease (AA) were compared to 12 participants free of asthma and atopic disease (AA). AA participants had the thickest carotid IMT (RCB=673.1 μm, RCCA=608.7 μm) and AA participants had the thinnest carotid IMT (RCB=588.5 μm, RCCA=557.3 μm). In fully adjusted models, both AA and AA participants had thicker RCB (Table 1) and trends toward thicker RCCA compared to AA participants.Discussion: In children with asthma and atopic disease, subclinical arterial injury was identified at a young age compared to children without asthma or atopy.