Implications of Recent Clinical Trials in Cardiovascular Imaging on Primary Prevention Therapies

Purpose of Review: This review aims to provide an overview of how cardiovascular imaging can help individualize preventive cardiovascular care, while focusing on the implications of various recent noninvasive and invasive imaging studies for the field of preventive cardiology. Recent Findings: Coronary artery calcium (CAC) has established itself as a well-validated tool for detecting the presence or absence of coronary atherosclerosis and thus can provide a more precise measurement of risk than many commonly used risk scores. While individuals with no CAC have an excellent prognosis, those with even minimal CAC have an increased risk of adverse cardiovascular outcomes. These findings have now been extended across several different patient cohorts, including younger patients (e.g., age 35–46 years), for whom the presence of any plaque is associated with a substantially higher risk. Aside from helping to guide the need for various preventive therapies, the detection of CAC may lead to improved risk factor modifications and enhance patient compliance. The implications of these studies include the fact that the incidental identification of CAC on nongated chest CT scans in patients without prior known CAD should prompt intensification of preventive therapies. Recent trials have suggested that among patients with stable symptoms, coronary CTA, as compared to functional testing, leads to higher initiation and intensification of preventive strategies, and a lower incidence of future myocardial infarction. As such, it imperative to use the results of cardiovascular imaging tests—which are often ordered to evaluate symptoms, and not necessarily for implementing preventive therapies—in a way that would promote more aggressive preventive therapies to individuals who have evidence of subclinical atherosclerotic cardiovascular disease. Summary: Cardiovascular imaging in both asymptomatic and symptomatic patients can have significant implications on long-term preventive treatments and allows for a more precise assessment of risk. Consequently, physicians should routinely incorporate the results of any available imaging studies together with clinical data, when deciding on the role and intensity of various pharmacologic and lifestyle changes. Communication of such findings with patients could enhance adherence and is essential for optimal patient-centered care.