Beta-thalassemia major (β-TM) in children is associated with an increase in the risk of premature cardiovascular complications caused by accelerated atherosclerosis which significantly contributes to morbidity and mortality. The molecular mechanisms underlying β-TM associated atherosclerosis and its relation to biochemical risk factors still remain obscure. We aimed to investigate the association between SIRT1 single nucleotide polymorphism (SNP), lipid profile, ferritin, malondialdehyde (MDA), 8hydroxydeoxy guanosine (8-OHdG) and total antioxidant capacity (TAC) in relation to carotid intima media thickness (CIMT) trying to explain some mechanisms of cardiovascular complication in beta-Thalassemia major (β-TM) children. This study was carried out on 100 Egyptian children with β-TM (Group II) subdivided equally according to CIMT into Group IIa, with CIMT<0.5 mm and Group IIb with CIMT ≥ 0.5 mm, in addition to 50 healthy children as controls (Group I). All groups were subjected to measurement of plasma Ferritin, lipid profile, MDA and TAC colorimetrically. 8-OHdG levels were estimated by enzyme-linked immunosorbent assay (ELISA) in addition genotyping pattern for the SIRT1 (rs7069102) SNP was evaluated using PCR-CTPP technique. Values for AIP, ferritin, MDA and 8-OHdG levels, were significantly higher in β-TM groups compared to control with higher levels in patients with CIMT more than 0.5 mm but values of TAC and (HDL-C) showed significant decrease. CIMT was significantly correlated with age, atherogenic index of plasma (AIP), ferritin, MDA and 8-OHdG, HDL-C and TAC. There was significant difference in C allele distribution of SIRT1 rs7096102 was 57% in control subjects, 29% in Group IIa and 23% in Group IIb. However, the allele G distribution was 43% in control subjects, 71% in Group IIa and 77% Group IIb. Significant association of SIRT1 (rs7069102) polymorphism with dyslipidemia, ferritin and oxidative stress may conduct atherosclerotic potential in β-TM by affecting the severity of CIMT.