Ultrasound imaging of the carotid artery tunica intima and tunica media, the two inner layers of the carotid artery, are used to help assess the health of the carotid arteries and the risk of cardiovascular disease-related events like heart attacks and strokes, even in asymptomatic patients. Risk factors for increased carotid intima media thickness (CIMT)  include aging, high cholesterol, hypertension, smoking, diabetes, obesity, and inactivity. The evaluation of CIMT has been used in a wide array of research studies to evaluate the effect of various diseases, conditions, and treatments on the vascular age of the arterial wall.  Evaluation of the CIMT has been added to the carotid Doppler protocol in many institutions because CIMT is significantly associated with a risk for myocardial infarction, stroke, death from coronary heart disease, or a combination of these events.