[Subclinical atherosclerosis. An objective index of susceptibility and vascular risk]

Clinical data suggest that the individual susceptibility to atherosclerosis is not accounted for only by exposure to classical or "emerging" vascular risk factors. Although recent investigations with transgenic animals have revealed new genetic determinants of susceptibility, little is known concerning this situation in human beings. Even though the human genome project might uncover specific genetic markers in the future, the only early and objective method to identify the susceptible individual at present is to detect atherosclerosis non-invasively. High resolution B-mode ultrasonography of superficial arteries coupled with advanced computer-assisted image processing systems is a highly reproducible method to perform a quali-quantitative early evaluation of already developed wall lesions. Clinically more significant, the detection of silent atherosclerosis has an additional value for risk factor assessment in the prediction of global vascular risk, a relevant index for decision-making in cardiovascular prevention. It is conceivable that the introduction of non-invasive measures of the atherosclerotic burden in risk stratification of asymptomatic subjects will help to target interventions for more rational risk factor control and to reduce the cost/benefit ratio of primary prevention.