LIPID METABOLISM: Edited by Derick Raal and Marina CuchelAssessment of atherosclerosis: should coronary calcium score and intima-media thickness be replaced by ultrasound measurement of carotid plaque burden and vessel wall volume?Spence, J. David Author Information Professor Emeritus of Neurology, Western University, and Director, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, 1400 Western Road, London, ON N6G 2V4, Canada Correspondence to J. David Spence, CM, MD, FRCPC, FAHA, Professor Emeritus of Neurology, Western University, and Director, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, 1400 Western Road, London, ON N6G 2V4, Canada. Tel: +1 519 931 5731; fax: +1 519 931 5737. e-mail: [email protected] Current Opinion in Lipidology 34(3):p 126-132, June 2023. | DOI: 10.1097/MOL.0000000000000880 Buy Metrics Abstract Purpose of review To describe the uses of vessel wall volume (VWV) and measurement of carotid plaque burden, as total plaque area (TPA) and total plaque volume (TPV), and to contrast them with measurement of carotid intima-media thickness (IMT) and coronary calcium (CAC). Recent findings Measurement of carotid plaque burden (CPB) is useful for risk stratification, research into the genetics and biology of atherosclerosis, for measuring effects of new therapies for atherosclerosis, and for treatment of high-risk patients with severe atherosclerosis. It is as predictive of risk as CAC, with important advantages. IMT is only a weak predictor of risk and changes so little over time that it is not useful for assessing effects of therapy. Summary Measurement of CPB and VWV are far superior to measurement of carotid IMT in many ways, and should replace it. Vessel wall volume can be measured in persons with no plaque as an alternative to IMT. There are important advantages of CPB over coronary calcium; CPB should be more widely used in vascular prevention. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.