Detection of Subclinical Atherosclerosis in Asymptomatic Individuals

Inclusion criteria

• Males between ages 35-90 or females between ages 40-90
• No known coronary artery disease

• no prior coronary disease by cardiac catheterization (no more than 40% in any major epicardial vessel)
• no prior myocardial infarction
• no prior ST-elevation myocardial infarction (1 mm ST-elevation in 2 contiguous leads)
• no prior non-ST-elevation myocardial infarction (CK-MB > 2x ULN or elevated troponin that is indicative of myocardial necrosis based on local institutional cutpoints)
• no prior coronary revascularization procedure
• Aymptomatic

• no chest pain, shortness of breath, angina or angina-equivalent that is assumed to be related to myocardial ischemia
• Presence of a high-risk feature (at least one of the following four will quality)

• High FRS ≥20% (http://hp2010.nhlbihin.net/atpiii/calculator.asp)
• Diabetes Mellitus
• Premature CAD in a first-degree relative
• High Risk Lipid Profile (must meet one of the following laboratory criteria)

• LDL > 250 mg/dL
• HDL < 20 mg/dL
• Triglycerides > 1000 mg/dL
• LP(a) > 80 mg/dL
• Provide written informed consent and Authorization for Use/Disclosure of PHI

Exclusion criteria

• Known genetic form of hypercholesterolemia based on clinical criteria (e.g. familial hypercholesterolemia, etc.)
• Creatinine 1.5 mg/dL or greater
• Irregular rhythm precluding cardiac CT examination
• Uncontrolled hypertension (SBP>210 mmHg or DBP>140 mmHg on treatment)
• Known moderate or severe allergy to iodine-based contrast agents (mild prior reactions that could be treated as an outpatient or that could be prevented by pre-medication in the past do not constitute exclusion)
• Known Pregnancy
• Unwilling or unable to consent
• Presence of any co-morbidity that makes life expectancy less than 24 months
• Unwilling or unable to complete follow-up
• Unwilling or unable to provide written informed consent and Authorization for Use/Disclosure of PHI