• Preventive cardiology efforts begin with assessment of CVD risk.
• Despite many available risk assessment approaches, a substantial gap remains in the detection of asymptomatic individuals who ultimately develop CHD.
• Most MIs are caused by low-grade stenoses.

Criteria required for a good screening test

• Provides an accurate determination of the likelihood that an asymptomatic person has the condition.
• Reproducible results.
• Detect individuals where early intervention is likely to have a beneficial impact.
• Should provide incremental value to risk predicted by office-based assessment.

Role for a complementary approach predicting ASCVD risk

• Global risk assessment with family history and other measures.
• Biomarkers (ideally predicting near-term risk).
• Subclinical disease imaging for atherosclerotic burden.