Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide with enormous social and economic cost implications. The ideal strategy for altering such a trend is optimum primary prevention. The European Society of Cardiology (ESC) guidelines 1 and recent American Heart Association/ American College of Cardiology (AHA/ACC) guidelines for CVD prevention 2 stress the central role of promoting a healthy lifestyle throughout life. The two guidelines recommend assessing conventional cardiovascular risk factors and calculate the 10-year risk of fatal CVD or 10-year probability of developing a first major cardiovascular event (myocardial infarction or stroke) by using the risk charts or scores. However, the benefit of using current CVD risk estimation models is limited. The use of the available tools, such as the SCORE of the ESC, may lead to serious underor over-estimation of cardiovascular risk, particularly in asymptomatic subjects considered at intermediate risk for events. Also, selected groups, such as young people and women, require special consideration for risk stratification. 3 Based on this, the ESC guidelines for CVD prevention proposed other factors that should be considered in order to better classify individuals into more appropriate risk categories. Among these factors is the search for objective evidence for subclinical atherosclerosis, such as coronary calcification and its score obtained by computed tomography (CT) or atherosclerotic plaque detection and measurements obtained from carotid artery ultrasound scans.Coronary artery scanning performed using cardiac CT and calculation of the Agatston calcium score is the most commonly used technique in clinical practice for detection of subclinical atherosclerosis, prognostic stratification of asymptomatic individuals and implementation of preventive strategies. Furthermore, like a coronary calcium score, a routine echocardiographic examination may offer an indirect evaluation of subclinical atherosclerosis disease by semi-quantitative assessment of cardiac calcifications at different sites, including the mitral apparatus (annulus, leaflets and papillary muscles), aortic valve and ascending aorta, that have been shown to predict future major coronary events, major cardiovascular events and mortality in asymptomatic subjects. 4,5 The Multi-Ethnic Study of Atherosclerosis, a population-based cohort with no known cardiovascular disease, reported the accuracy of coronary artery calcium score in predicting clinical events. A calcium score greater than 300 accurately identified subjects at high risk for future coronary heart disease events, with a hazard ratio of nearly 10. 6,7 Likewise, visualization of asymptomatic subclinical carotid atherosclerosis can improve an individual's risk classification and consequently guide towards a tailored optimum prevention strategy, one of the most important being lipid lowering therapy, and the eligibility for statin therapy. In 'The BioImage Study ', 8 Mortensen et al. proposed a personalized ap...