An Emerging Paradigm in Atherosclerosis: Focus on Subclinical Disease

Atherosclerosis is a generally asymptomatic process that begins early in life and eventually leads to clinically overt coronary heart disease (CHD), with the age of onset determined by genetics, environment, and associated interactive factors. Early diagnosis and treatment of subclinical atherosclerosis in asymptomatic patients who are at risk of developing clinically evident atherosclerosis may help prevent CHD and future coronary events. New understanding of the role of atherosclerotic plaque burden in predicting risk for CHD and the development of new technologies for evaluating coronary plaque have improved our ability to assess risk in asymptomatic patients who may have subclinical disease. Assessment technologies including coronary angiography, intravascular ultrasound, B-mode ultrasound, and electron-beam computed tomography have been used widely in clinical studies of statin treatment in patients with and without CHD. Results from these studies show that statins not only lower lipids but inhibit progression and, in some instances, lead to regression of coronary plaques. The unique combination of benefits provided by statin therapy may have an application in treating subclinical atherosclerotic disease.