The non-invasive cardiovascular study of preclinical atherosclerosis: role in the screening of asymptomatic people at risk.

Cardiovascular diseases still represent the leading cause of death in developed countries and are largely related to atherosclerosis. Primary prevention is the most effective approach but requires the identification of asymptomatic people at increased risk to be submitted to preventive treatments. Currently, population screening is made using traditional cardiovascular risk factors model from the Framingham study. With this method, however, a relevant part of the population is classified as intermediate risk with unclear indication to an intensive treatment of risk factors. To better characterize these individuals, new risk indicators, both biochemical and instrumental have been proposed for use in screening. The most investigated non-invasive instrumental methods are the study of the pulse wave velocity, the analysis of endothelial function, the measure of the carotid intima-media thickness, the calculation of the ankle brachial index and the measurement of the coronary calcium score. Some of them, especially the coronary calcium score, showed strong correlations with the development of cardiovascular events and would seem to be able to significantly improve the prediction of the risk score when added to traditional risk factors, allowing the correct reclassification of subjects in intermediate risk in over 50% of cases. Nevertheless, methodological limits of standardization and repeatability and concerns on the complete harmlessness (in the case of coronary calcium), together with the lack of efficacy data from interventional studies, have so far made little spread their use.