Objective: Patients with borderline personality disorder (BPD) may have a higher risk of developing cardiovascular disease caused by altered endocrine, metabolic, and inflammatory parameters. Increased intima-media thickness (IMT) is considered an early marker of atherosclerosis and is associated with most cardiovascular risk factors. Methods: The mean IMT of the common carotid arteries was assessed by B-mode ultrasound in 47 women with BPD and 28 age-matched healthy women. Mean (standard deviation) age for BPD participants was 31.2 (10.4) years and 31.9 (11.0) years for the comparison group. In addition, Adult Treatment Panel III criteria for metabolic syndrome and markers of inflammation were measured. The patients were characterized by applying DSM-IV criteria and obtaining self-reports of adverse childhood experiences. Results: Women with BPD had a significantly higher IMT than healthy women (mean [standard deviation] = 0.41 [0.11] versus 0.34 [0.11] mm, p = .02). In linear regression analysis, IMT was significantly associated with BPD even when adjusting for body mass index (A = 0.27, p = .04) and physical activity (A = 0.29, p = .02). Conclusions: The data suggest that women with BPD are at increased risk of developing subsequent cardiovascular disease.ACEs = adverse childhood experiences; BDI = Beck Depression Inventory; BMI = body mass index; BPD = borderline personality disorder; CG = comparison group; IMT = intima-media thickness; MDD = major depressive disorder; SCID = Structured Clinical Interview for DSM-IV.