Skipping breakfast is associated with an increased prevalence of atherosclerosis, according to new findings from the PESA study. For this cross-sectional study, 4,052 asymptomatic participants (aged 40–54 years) were compared on the basis of their breakfast patterns: high-energy (>20% of total daily energy intake; 27% of participants), low-energy (5–20% of total daily energy intake; 70% of participants), and no breakfast (<5% of total daily energy; 3% of participants). Regularly skipping breakfast was associated with a higher prevalence of noncoronary (OR 1.55) and generalized (OR 2.57) atherosclerosis compared with having a high-energy breakfast, independently of traditional and dietary cardiovascular risk factors. Modification of eating patterns is a low-cost approach for primary prevention with potentially large benefits for health.