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Between risk charts and imaging: how should we stratify cardiovascular risk in clinical practice?

Cardiovascular (CV) risk prediction has a central role in primary CV prevention. Several risk charts have been developed in the attempt to identify subjects at risk who might benefit from more aggressive interventions. However, risk charts show main limitations and they remain underutilized in general practice. The addition of novel risk markers has substantially failed to improve risk charts discrimination power. Imaging has recently gained relevance in CV risk stratification for its ability to detect subclinical atherosclerosis. Although extending non-invasive imaging to all asymptomatic middle-aged people is currently not recommended, its progressive spread may provide information on preclinical atherosclerosis and detection of de facto initial disease might overcome some limitations of conventional risk stratification charts.