Early identification of atherosclerotic disease by noninvasive imaging

Cardiovascular disease (CVD) is the leading cause of death worldwide, and its prevalence is expected to increase further, which will be associated with a substantial economic burden. High-risk or vulnerable plaques and, indirectly, the burden of atherosclerotic disease, are responsible for most major cardiovascular events. Most of the current prevention strategies are focused on identifying and managing the established risk factors (smoking, hypertension, hypercholesterolemia, diabetes, obesity, physical inactivity) for atherosclerosis. Another opportunity for further characterizing the population at high CVD risk would be to measure the occurrence and progression of subclinical (asymptomatic) atherosclerotic burden. The detection of subclinical atherosclerosis and high-risk plaques, if proven to predict cardiovascular events, may enable the establishment of earlier control of CVD risk factors and help preventing CVD. In this Review, we address the potential progress in CVD prevention brought about by the use of noninvasive imaging techniques to identify subclinical atherosclerosis.