Biomarkers and Imaging Modalities to Detect Subclinical Atherosclerotic Cardiovascular Disease

Atherosclerosis, the underlying cause of cardiovascular disease, exists at a subclinical level a decade or more before the onset of sudden and unpredictable cardiovascular events. Biomarkers and imaging modalities are useful tools to augment and individualize risk predictions in an asymptomatic population. This chapter focuses primarily on biomarkers and imaging modalities of subclinical atherosclerotic cardiovascular disease currently available for use by practicing clinicians but also describes some of the emerging biomarkers and imaging modalities that will likely soon come into use. Due to the multifactorial nature of atherosclerosis, there is no single marker or imaging test with high specificity, which can unambiguously assess the severity of atherosclerosis and help in the prognosis and guideline-based treatment of cardiovascular risk. Rather, a combination of biomarkers and noninvasive imaging tests better predicts major adverse cardiovascular events, especially in populations where the risk estimation may not be applicable (i.e., familial hypercholesterolemia), or where they may underestimate risk in some populations or overestimate risk in populations with protective risk conditions.