Diagnosis of subclinical coronary atherosclerosis: challenges and insight

Abstract

In the last 30 years, significant progress has been made in our ability to stratify individuals on the basis of cardiovascular (CV) risk, allowing those at the highest risk of CV disease to be more aggressively treated. In the US, this has resulted in a gradual decline in CV mortality. Whether medical interventions in individuals at low-to-intermediate risk for CV disease translate into improved outcomes remains an open question, and depends largely on our ability to diagnose atherosclerosis at an earlier stage than is possible at present. The objective of this paper is to review current literature on the diagnosis of subclinical atherosclerosis. Medline searches for peer-reviewed publications using search terms relevant to the diagnosis of subclinical atherosclerosis were performed. Data from these references are discussed and grouped into three broad categories, including biomarkers, imaging and genomics. The recent identification of new biomarkers and genes associated with atherosclerosis combined with recent advances in cardiovascular imaging has enhanced our understanding of atherosclerosis. These techniques show promise in their ability to detect subclinical atherosclerosis indepenedent of conventional clinical CV risk factors. Further research is needed better to define roles for these technologies in the diagnosis of atherosclerosis among asymptomatic individuals.