Evidence of the association between job strain, that is, a combination of high psychological demands and low job control, and markers of atherosclerosis is mixed, but few studies with repeat measures are available. The purpose of this study was to examine cross-sectional and longitudinal associations between job strain and atherosclerosis. The participants were 335 men and 374 women from the prospective Cardiovascular Risk in Young Finns study (mean age 38.5 years). Two sequential measurements of job strain and carotid intima-media thickness (IMT) were analyzed. No cross-sectional or longitudinal association between job strain and IMT was observed in women. In men, a cross-sectional association was found in 2001, but not in 2007. No dose-response effect was visible, nor a simple association between progression of job strain and progression of IMT. Instead, a more complex pattern of correlation was found in men with large decreases in job strain being associated with slower progression of IMT and combined decreases in job control and demands (a change toward passive jobs) being associated with greater IMT progression. These data suggest that temporal changes in job demands and control are associated with IMT in men via multiple mechanisms.