Current landscape in cardiovascular risk stratification. A schematic representation of coronary luminal stenosis over ageing (chronological or biological) is shown at the top. It is estimated that ∼6.5% of the general population will develop obstructive coronary artery disease during their lifetime. At the early stages of disease, before the clinical manifestations of atherosclerosis, cardiovascular risk stratification is based on the assessment of the clinical profile and the use of risk scoring systems (which usually have modest predictive accuracy). In asymptomatic subjects, risk prediction can be further enhanced by coronary calcium scoring. Non-invasive diagnostic assessment of symptomatic subjects relies on functional stress imaging or anatomical assessment by coronary computed tomography angiography. However, ∼50% acute coronary syndrome occur in patients without any obstructive plaques,69 for whom usual functional imaging tests are of limited diagnostic value. Novel, accurate, and cost-effective ways for cardiovascular risk discrimination (e.g. assessment of coronary inflammatory burden) would allow the deployment of more effective prevention treatment strategies and save lives, but appropriate screening tools for the detection of coronary inflammation have been lacking.
