AIM: Low adherence to a healthy lifestyle constitutes a major barrier to effective prevention of cardiovascular disease. We aimed to investigate the effect of pictorial-based information about subclinical atherosclerosis on adherence to health-promoting lifestyle recommendations. METHODS: Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) is a pragmatic, open-label randomised controlled trial within the Västerbotten Intervention Programme (VIP) in Sweden. In the VIP, residents of Västerbotten county are invited to a health survey and a health-promoting dialogue at the ages of 40, 50 and 60.A total of 3532 VIP participants were included in VIPVIZA during 2013-2016. They underwent a carotid ultrasound examination in addition to the usual VIP process and were randomised 1:1 to intervention group (receiving graphical colour-coded and age-related information about carotid intima-media thickness and plaques, written information about atherosclerosis and a motivational dialogue) or control group (no information or dialogue).We developed a lifestyle index based on self-reported physical activity, smoking habits, diet and alcohol consumption, ranging from 4 to 12, with higher levels indicating healthier lifestyles. We used ordinal regression to compare the lifestyle index in the intervention and control groups at the 3-year follow-up, with adjustments for baseline levels of lifestyle index, age, sex and education. RESULTS: The OR for having a healthier lifestyle index after 3 years was 1.20 (95% CI 1.01 to 1.42, p=0.03), comparing the intervention group to the control group. We found no interactions for age, sex or education. CONCLUSION: Our findings provide some evidence for the contributory role of pictorial-based information about subclinical atherosclerosis in promoting sustained healthy lifestyle habits. TRIAL REGISTRATION NUMBER: NCT01849575.