Subclinical atherosclerosis: how and when to treat it?

Atherosclerosis is a condition characterized by a long, initial, asymptomatic phase. Progression of disease could lead to acute coronary events, such as acute myocardial infarction, unstable angina, or sudden cardiac death. However, there are imaging techniques, namely vascular echography and assessment of coronary calcium, capable to make the diagnosis of atherosclerosis at an early stage. There are several studies demonstrating the ability of statins to delay, and in some situation even revert the progression of this condition. Subclinical atherosclerosis is highly prevalent in people with optimal control of the risk factors, and the imaging techniques have been shown to provide an added value over the traditional risk factors: by identifying directly the condition, these techniques allow the reclassification of low-risk to intermediate- or high-risk subjects, thus directing the primary prevention therapeutic strategies, based on high efficacy statins, aimed at delaying or reversing the progression of the disease.