Objective To evaluate the association between the severity of nasal obstruction and carotid intimamedia thickness (IMT) in patients with NSD. Methods This prospective study included 60 patients scheduled for septoplasty and 50 age-, sex-, and BMI-matched healthy controls. Correlation analyses and ROC curve analyses wereperformed to determine associations and optimal cut-off values. Results Both right (0.62 ± 0.12 mm) and left (0.63 ± 0.12 mm) CCA-IMT values were significantlyhigher in the NSD group compared to controls (0.51 ± 0.09 mm and 0.51 ± 0.07 mm,respectively; p < .001). ROC analyses revealed that VAS ≥ 7.5 (sensitivity 85.7%, specificity 67.4%) and NOSE ≥ 72.5 (sensitivity 92.9%, specificity 65.1%) reliably predicted elevatedcarotid IMT (>0.7 mm). Conclusions NSD-related nasal obstruction was significantly associated with increased carotid IMT,suggesting a possible contribution to cardiovascular risk. Larger multicenter studies are warranted to validate these findings. The Australian New Zealand CTN:ACTRN12619000347167