Pulse wave velocity (PWV), a measure of arterial stiffness, and intima-media thickening (IMT), a measure of early atherosclerosis, are intermediate markers of cardiovascular disease which are predictive of cardiovascular events. Traditionally, both were thought to result from accumulative exposure to traditional cardiovascular risk factors. However, their association with risk factors in young adults in low-income settings is unknown. We sought to investigate the association between PWV and IMT with traditional cardiovascular risk factors in the Andhra Pradesh Children and Parents Study cohort from Southern India. Male and female adults (N = 1440) aged between 20 and 24 years underwent measures of PWV and IMT. Exposure variables included smoking, body mass index (BMI), mean arterial pressure (MAP), glucose, homeostatic model assessment of insulin resistance (HOMA-IR), total cholesterol, high-density lipoprotein cholesterol (HDL-cholesterol), and triglycerides. Association between outcome and exposure variables was assessed using linear regression analysis. Average values for PWV and IMT were 5.9 ± 0.6 m/s and 0.5 ± 0.1 mm. In univariable analysis, PWV associated with MAP, BMI, smoking, total cholesterol, glucose, and HOMA-IR and IMT associated with MAP, BMI, tobacco use, and HDL-cholesterol. In multivariable analysis, PWV remained strongly positively associated with MAP increasing by 0.5 m/s (P < .001) for a 10 mm Hg increase in MAP (R2  = .37). In contrast, IMT negatively associated with HDL-cholesterol (β = -.10; P = .012, R2  = .02). There was weak evidence that PWV and IMT positively associated with BMI. In young adults from Southern India, PWV positively associated with blood pressure and IMT negatively associated with HDL-cholesterol. This suggests separate etiologies for atherosclerosis and arterial stiffening in young adults.