During the last decades, new developments in the detection and therapy of dyslipidemia provided a firm conviction for the efficacy and the safety of lipid-lowering therapies in primary and secondary prevention of cardiovascular diseases. To be cost-effective in primary prevention, the statin-therapy needs to select high risk patients. According to the guidelines, the global assessment of cardiovascular risk is based on traditional risk factors (RF-CV). The emergence of new RF-CV is helpful. However, at every level of risk factor exposure, there is a substantial variation of atherosclerosis. Thus, subclinical disease measurements, representing the end result of risk exposure may be useful for improving cardiovascular risk prediction. Using the high resolution B-mode ultrasound to detect plaques both on femoral and carotid arteries in asymptomatic patients, our results show the advantages and limits of a non invasive method to improve the selection of eligible patients requiring a more aggressive lipid-lowering therapy.