Screening Asymptomatic Subjects for Subclinical Atherosclerosis: Can We, Does It Matter, and Should We?

Unheralded vaso-occlusive cardiovascular events (myocardial infarction, sudden death, and stroke) are common manifestations of atherothrombotic vascular disease, and accurate identification of individuals at risk of such events is highly desirable. Risk factor assessment and management have been the cornerstones of preventive strategies but are constrained by less than desirable accuracy and less than optimal compliance, respectively. In selected populations, noninvasive imaging using carotid ultrasound and/or coronary calcium score can incrementally refine risk assessment and may allow for improved adherence and better matching of preventive interventions to the magnitude of risk. Further refinements in the future may also be possible with novel biomarkers and measures of plaque phenotype.