Purpose of review: The goal of this review is to update the contributions of subclinical atherosclerosis imaging of coronary artery calcified plaque (CAC) to the primary prevention of coronary artery disease.
Recent findings: Recent articles have increased support for the following: superiority of CAC determined risk to conventional risk factor-based paradigms, reclassification of risk by CAC, serial CAC scanning to assess the efficacy of therapy, CAC evaluation of high-risk groups (diabetes and other disease states characterized by inflammation), and redefinition of normal and abnormal lipids, ideal treatment goals and residual risk, as well as statin potency.
Summary: The paradigm shifts implicit in the supremacy of CAC herald a transformation in primary prevention from conventional risk factor paradigms to the evaluation of the disease itself by subclinical atherosclerosis imaging.