This study investigates vascular alterations and cardiovascular risk in patients with rheumatoid arthritis (RA) using high-resolution carotid ultrasound. RA is associated with accelerated atherosclerosis and a disproportionately high burden of cardiovascular disease (CVD), yet subclinical vascular changes remain underdiagnosed in routine practice. In this cross-sectional analysis, ultrasound evaluation included measurements of carotid intima-media thickness (cIMT), assessment of focal atherosclerotic plaques, and quantification of plaque burden. Cardiovascular risk factors were evaluated separately from RA-specific factors to determine their independent contributions. RA patients demonstrated a higher prevalence of carotid plaques, increased plaque counts, and more frequent subclinical atherosclerotic changes compared with age-matched controls. These findings support the growing evidence that carotid ultrasound is a valuable screening tool for identifying early vascular involvement in RA—even in patients without overt cardiovascular symptoms. This preprint provides baseline data intended to support future longitudinal analyses and may inform strategies for early cardiovascular risk stratification in RA populations. All patient data were anonymized, and no identifiable information was used.