Introduction: Carotid intima-media thickness (CIMT) is a predictor marker of subclinical atherosclerosis that can be measured by ultrasound technique. The clinical symptoms of atherosclerosis usually begin with the thickening of the carotid artery walls. Polymorphism in Apolipoprotein E4 (APO-E4) is considered to be an important genetic determinant of atherosclerosis and Coronary Artery Disease (CAD). The genetic role of APO-E4 on plasma lipid has shown that the APO-E4 allele is associated with increased plasma LDL and total lipid concentration. The main objectives of this study were to identify genotype polymorphisms of the APO-E gene and measure the thickness of the carotid intima in subjects with APO-E4 polymorphisms in the first descendant of coronary heart patients. Patients and methods: A cross-sectional study design was used to determine the polymorphism of the APO-E4 genotype in the first descendant of CAD and non-CAD groups. There were 21 samples in each group. Gene polymorphism examination was carried out by PCR and the CIMT was measured with doppler ultrasound. Results: The result showed that 21.4% of subjects had polymorphism of the APO-E4 genotype with a significant difference between CHD and non-CHD group. This data shows that the APO-E4 genotype is more dominant in the first descendant of patients with CHD when compared to non-CHD parents. The mean values of CIMT ini right and left-sided carotid arteries among APO-E4 genotype and non-APO-E4 genotype were 0.4743 mm vs. 0.4195 mm and bivariate analysis showed a significant difference with a P-value of 0.017. This shows that there is a significant difference in the thickness of the carotid intima in the first descendant of subjects who have the APO-E4 genotype and those who do not. Conclusion: The APO-E4 gene polymorphism was more dominant in the first descendant of CAD patients with a higher CIMT mean value.