Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD), which is attributed to inflammatory processes that accelerate atherosclerosis. Therefore, the exploration of novel biomarkers association is needed. This study investigated the associations between serum trace elements (Fe, Zn, Mg, Se, and Sr) and surrogate markers of CVD in 219 RA patients and compared them with those with metabolic disorders (MetD, n = 82) and control participants (n = 64). Surrogate markers included carotid intima-media thickness (cIMT), carotid plaque presence (cPP), pulse wave velocity (PWV), distensibility (DIST), and the augmentation index (AIx). RA patients displayed heightened inflammatory markers, increased arterial stiffness and thickness, and elevated CV risk factors. Compared with those in control participants, Se levels in RA patients were lower, regardless of sex. Women and men with RA had lower Sr and Mg levels than those with MetD, respectively. Backward regression models demonstrated inverse associations of Sr and Zn with cIMT in men with RA and those with MetD, respectively. In RA patients, Sr and Zn were predictors of an increased AIx, with sex-specific associations. Increased Fe levels were associated with an increased AIx in women with MetD. Fe and Zn were predictors of increased cIMT in control participants, with sex-specific associations. Serum trace elements are independently associated with surrogate markers of CVD in patients with RA, highlighting their potential role in CV risk assessment. Prospective studies are essential for validating these associations and establishing optimal trace element levels for managing CVD risk in patients with RA.