Non-invasive measurements of atherosclerosis (NIMA): current evidence and future perspectives

In clinical practice, cardiovascular (CV) risk stratification is based on the assessment of individual risk factors. Still many cardiovascular deaths occur in individuals who were not at high risk according to the current CV risk stratification models as the Systematic COronary Risk Evaluation chart (SCORE) and Framingham Risk Score. By measuring morphological and÷or functional abnormalities in the arterial wall directly, the impact of all CV risk factors together can be determined. In this review, the current status for the use of a panel of non-invasive measurements of atherosclerosis (NIMA) in CV risk prediction in clinical practice is discussed. Some of these NIMA showed predictive value for CV disease, such as intima-media thickness, pulse wave velocity, and ankle-brachial index, both in patients and in healthy and community-based populations. Recommendations have been made to include these NIMA in CV risk stratification in secondary prevention. However, the additional value of NIMA in CV risk stratification in primary prevention settings remains to be determined. Furthermore, the main determinants of NIMA are still unclear. Also the use of different combinations of NIMA should be evaluated, since different NIMA likely reflect different stages and aspects of the atherosclerotic process that leads to CV events. Future prospective studies should focus on repeated measures of NIMA to reveal the main determinants of the different NIMA and evaluate the predictive value of baseline versus repeated measurements.