Introduction : Atherosclerosis is asymptomatic and its complications are chronic, slowly progressive and cumulative. Serum ferritin tends to increase in ?-thalassemia major cases; hence, it can become an indicator for premature atherosclerosis. . The risk of atherosclerosis is high in ?-thalassemia major cases. Objectives : To identify the relationship between serum ferritin and premature atherosclerosis in children with ?-thalassemia major. This research also provided the prevalence and correlation of premature atherosclerosis between serum ferritin level and lipid profile Material and Methods : This research was an analytical cross-sectional study in pediatric clinic Haji Adam Malik Hospital from July to November 2019. Echocardiography was used to measure carotid intima-media thickness, while serum ferritin and lipid levels were measured from laboratory analysis. Data analysis was done by using SPSS software. Mann-Whitney test was used to observe the relationship between serum ferritin and premature atherosclerosis, and Spearman correlation test was used to observe the correlation between serum ferritin and lipid. Result : Among 35 research samples, 6 children (17%) suffered from premature atherosclerosis with mean CIMT 0.6 ? 0.27 mm. The mean values of triglyceride in patients with and without atherosclerosis were 141 (SD 41.3) mg/dl and 117 (SD 41.8) mg/dl respectively (p = 0.203). There was no significant relationship found between serum ferritin and premature atherosclerosis in children with ?-thalassemia major (p = 0.708).