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Decline in the Severity of Carotid Atherosclerosis and Associated Risk Factors From 2002 to 2014. Background and Purpose- Several recent studies suggest declining rates of carotid revascularization for patients with carotid stenosis. We investigated whether carotid atherosclerosis severity has declined in recent years. Methods- We used carotid ultrasound to evaluate stenosis and plaque area in 6039 patients presenting to vascular medicine clinics in 3 eras: 2002 to 2005, 2006 to 2009, and 2010 to 2014. Results- The total plaque area at the time of referral to the clinics declined by 24% between 2002 and 2014; the percentage of patients presenting with carotid stenosis >60% declined by 29.9%, and the number presenting with >80% stenosis declined by 36.4%. There were significant reductions in plasma lipids and blood pressure during the same interval. Conclusions- Atherosclerosis severity seems to be declining over time. Better treatment of risk factors in the community may be responsible.