Carotid atherosclerosis is the main cause of stroke - the fourth leading cause of death in Canada - and can be quantified by ultrasound measurements. Intima-media thickness (IMT), total plaque area (TPA) and 3-dimensional ultrasound vessel wall volume (3DUS VWV) were compared in a longitudinal study of 71 patients with diabetic nephropathy randomized to vitamin B or placebo. Only 3DUS VWV was sensitive to a difference in change between treatment groups. We developed and tested cardiac-gated 3DUS acquisition for use in younger subjects with compliant arteries; images were acquired from 400 ms after the start of the cardiac cycle to the beginning of the next cardiac cycle. In healthy volunteers and rheumatoid arthritis patients, change in area over the cardiac cycle was reduced to below that seen in moderate atherosclerosis patients. 3DUS VWV can measure change in atherosclerosis and can now be used in younger patients at risk of atherosclerosis in future studies