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Atherosclerosis is now the world’s commonest cause of death and disability. Although it usually causes clinical complications in middle and late age, novel imaging studies have shown that the disease process begins in childhood and young adult life. Non-invasive imaging of these early changes have allowed studies into risk and disease reversibility. Pulmonary vascular disease is a rarer but devastating form of arteriopathy. Currently this is diagnosed late in its natural history, when pulmonary pressures rise. Recent studies have utilised nuclear imaging, stress echo and wave intensity analyses to detect early changes, when treatments are more likely to be effective. In this talk, Professor Celermajer will outline his groups pioneering studies in the use of Imaging for the early detection of systemic and pulmonary vascular diseases.