Routine Handheld Carotid Ultrasonography for Cardiovascular Risk Stratification and Primary Prevention Treatment Decisions in a Contemporary Middle‐Aged General Population

urrent European guidelines for primary atherosclerotic cardiovascular disease (ASCVD) prevention recommend treatment decisions to be based on estimating the 10-year ASCVD risk with the Systematic Coronary Risk Evaluation 2 (SCORE2) model and using age-dependent cutoffs to define ASCVD risk categories. 1 Despite the evidence-based validity of this approach, there is no consideration of factors such as the duration of exposure to a risk factor and relevant drug treatment, or the impact of very high levels of high-density lipoprotein cholesterol and of risk modifiers. 2symptomatic carotid atherosclerosis has been reported to provide incremental predictive value for ASCVD events over risk factors alone and contributes to considerable ASCVD risk restratification. [2][3]3][4][5] In a recent study, the degree of carotid atherosclerosis determined by carotid plaque score (CPS) was found to