Aim: To evaluate the relationship between coronary risk and carotid vessels as revealed by duplex study in diabetic elderly patients. Method: Case control study was designed. Participants were recruited from Geriatric department Ain Shams University Hospital, Cairo-Egypt. The cases were subdivided into two groups (group 1: diabetic with coronary artery diseases (CAD), group 2: diabetic without CAD). The diabetic group (cases) included 60 patients (25 males and 35 females). The control group included 30 elderly subjects matched for age and sex. All groups were subjected to: comprehensive geriatric assessment, laboratory measurements including: fasting blood sugar, lipid profile, lipoprotein (a), and carotid duplex for measurement of the intima-media thickness and the degree of stenosis. Result: On analysis of the collected data, diabetic patients did have atherosclerosis in the carotid arteries more than the non diabetic subjects, and among the diabetic patients group, it was revealed that those who had CAD, had their carotid arteries more atherosclerotic than the others without CAD. Multinomial logistic regression done showed significant independent association between the presence of thickened carotid intima-media and coronary artery disease among diabetic patients (p=0.042, OR 1.71(0.52-5.6) Conclusion: Thickened carotid intima-media can predict risk to have coronary artery disease among elderly diabetic patients.