Screening asymptomatic subjects for subclinical atherosclerosis: can we, does it matter, and should we?

Area of Science:

• Cardiovascular Medicine
• Vascular Biology
• Preventive Cardiology

Background:

• Atherothrombotic vascular disease causes unheralded vaso-occlusive cardiovascular events like myocardial infarction, sudden death, and stroke.
• Current risk factor assessment has limitations in accuracy, and management compliance is suboptimal.
• Accurate identification of high-risk individuals is essential for effective prevention.

Purpose of the Study:

• To evaluate the role of noninvasive imaging in refining risk assessment for atherothrombotic events.
• To explore strategies for improving adherence to preventive interventions.
• To identify individuals who would benefit most from targeted preventive therapies.

Main Methods:

• Review of current risk assessment strategies for atherothrombotic vascular disease.
• Analysis of the incremental value of carotid ultrasound and coronary calcium scoring in risk stratification.
• Discussion of potential future advancements, including novel biomarkers and plaque phenotype analysis.

Main Results:

• Noninvasive imaging, specifically carotid ultrasound and coronary calcium scoring, can enhance the accuracy of cardiovascular risk assessment in selected populations.
• These imaging modalities may lead to improved patient adherence to preventive measures.
• Personalized preventive strategies can be better matched to individual risk levels.

Conclusions:

• Noninvasive imaging offers a valuable adjunct to traditional risk factors for identifying individuals at high risk of atherothrombotic events.
• Improved risk stratification through imaging can optimize the implementation of preventive interventions.
• Future research into novel biomarkers and plaque imaging holds promise for further enhancing cardiovascular risk prediction.