Atherosclerosis. 2024 Mar 19:117515. doi: 10.1016/j.atherosclerosis.2024.117515. Online ahead of print. ABSTRACT BACKGROUND AND AIMS: Atherosclerosis is accompanied by pre-clinical vascular changes that can be detected using ultrasound imaging. We examined the value of such pre-clinical features in identifying young adults who are at risk of developing atherosclerotic cardiovascular disease (ASCVD).