This study evaluates the role of Carotid Intima-Media Thickness (CIMT) in predicting coronary artery disease in Black South Africans, and to correlate CIMT with the known risk factors for coronary artery disease, including those of the Metabolic Syndrome. Findings show that CIMT predicts the extent of coronary artery diseases as found at coronary angiography. Multiple regression analysis identified hypertension and fasting glucose as the most important determinants of CIMT. Age, obesity, smoking and LDL-Cholesterol also correlated positively with CIMT. The results suggest that in this population, hypertension and diabetes are crucial in the pathogenesis of thickening of the intima-media of carotid arteries, a surrogate marker of coronary artery disease.