 Introduction/Background In the United States, atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death for both men and women [1]. Although improvements in awareness, knowledge, and medications have led to a decrease in death rates, the burden of disease remains very high [1,2]. Identification of patients who may benefit from early intervention prior to development of symptoms has been shown to reduce mortality and morbidity [3]. There is a well-established discordance between the prognostic accuracy of current risk estimation scores versus imaging when directly measuring the burden of atherosclerosis for the assessment of individual ASCVD risk as a guide to optimally manage preventive therapies [6]. Imaging allows for the detection of subclinical coronary atherosclerosis. Patients with familial hyperlipidemia in particular have a high prevalence of subclinical coronary atherosclerosis that is independently associated with cardiovascular risk [7]. The coronary artery calcium (CAC) score is a validated measure of overall coronary atherosclerotic burden, the strongest known imaging measure of risk in asymptomatic individuals. Individual data derived from this and other imaging tests provide useful prognostic information for patient management and can complement current risk prediction models [8]. The purpose of this document is to discuss the use of diagnostic imaging tests in asymptomatic patients who are at elevated risk of future cardiovascular events related to atherosclerosis. The tests are to improve targeted preventive efforts based on patient risk and are aimed at identification of CAD. aPanel Vice-Chair, Massachusetts General Hospital, Boston, Massachusetts. bResearch Author, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. cPanel Chair, Duke University Medical Center, Durham, North Carolina. dUniversity of Louisville School of Medicine, Louisville, Kentucky.
Asymptomatic Patient at Risk for Coronary Artery Disease PCAs.  Introduction/Background In the United States, atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death for both men and women [1]. Although improvements in awareness, knowledge, and medications have led to a decrease in death rates, the burden of disease remains very high [1,2]. Identification of patients who may benefit from early intervention prior to development of symptoms has been shown to reduce mortality and morbidity [3]. There is a well-established discordance between the prognostic accuracy of current risk estimation scores versus imaging when directly measuring the burden of atherosclerosis for the assessment of individual ASCVD risk as a guide to optimally manage preventive therapies [6]. Imaging allows for the detection of subclinical coronary atherosclerosis. Patients with familial hyperlipidemia in particular have a high prevalence of subclinical coronary atherosclerosis that is independently associated with cardiovascular risk [7]. The coronary artery calcium (CAC) score is a validated measure of overall coronary atherosclerotic burden, the strongest known imaging measure of risk in asymptomatic individuals. Individual data derived from this and other imaging tests provide useful prognostic information for patient management and can complement current risk prediction models [8]. The purpose of this document is to discuss the use of diagnostic imaging tests in asymptomatic patients who are at elevated risk of future cardiovascular events related to atherosclerosis. The tests are to improve targeted preventive efforts based on patient risk and are aimed at identification of CAD. aPanel Vice-Chair, Massachusetts General Hospital, Boston, Massachusetts. bResearch Author, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. cPanel Chair, Duke University Medical Center, Durham, North Carolina. dUniversity of Louisville School of Medicine, Louisville, Kentucky.