Role of coronary calcification scanning in risk factor assessment.

Coronary artery disease will soon be the leading cause of death in the world. Given the long period during which coronary atherosclerosis progresses silently and without symptoms, often followed by an abrupt presentation of acute myocardial infarction or sudden death, the need for identification of persons at high risk and an aggressive preventive approach seems clear. The roles of lifestyle modification, lipid-lowering drug therapy, and platelet inhibition in reducing the risk of coronary events in secondary prevention are well established. However, decisions about whom to treat with drugs in primary prevention are considerably more difficult. Unfortunately, most. of our conventional screening tools to detect coronary artery disease, such as stress testing and perfusion imaging, rely upon a flow limiting coronary plaque. Furthermore, it has been estimated that only about half of the variation in coronary artery disease (CAD) can be explained by known traditional risk factors [1]. There is a clear need for diagnostic tools that predict future development of clinical coronary disease in patients who have not yet developed symptoms.