Subclinical atherosclerosis represents the vessel memory of risk factor exposure.

A very interesting review paper on coronary artery calcium screening in the European Heart Journal.

Their conclusions:

Computed coronary tomography allows for quantification and localization of CAC as a sign of subclinical atherosclerosis. The SHAPE (Screening for Heart Attack Prevention and Education) Task Force presented a practice guideline for cardiovascular screening in the asymptomatic risk population based on signs of subclinical atherosclerosis.

This practice guideline could, however, not be based on prospective observational cohort studies, which are now available and thus these aspects were further emphasized including other tasks for subclinical atherosclerosis such as ultrasound of the carotid artery and screening with biomarkers.

Coronary artery calcification can be used for risk stratification and has already received a class IIa recommendation by the ACC/AHA. Coronary artery calcification should be in the focus of cardiologists particularly for those who are interested in preventive cardiology because important and unique insights in CAD can be provided. Coronary atherosclerosis represents the memory of lifetime risk factor exposure, and has a significant short- term and intermediate term prognostic implication. Our colleagues who experienced a sudden fatal event just like thousands of other people, unaware of their risk, should stimulate us to improve primary prevention by using signs of subclinical atherosclerosis as a marker of risk.