Current and future directions of cardiovascular risk prediction.

Coronary artery disease (CAD) prevention has moved beyond the secondary prevention of CAD events to the early identification and treatment of individuals thought to be at risk. Risk categories may be linked to the presence of other diseases, such as diabetes mellitus or noncoronary atherosclerotic disease, or to the finding of multiple risk factors on global risk assessment. Global risk assessment is now recommended as standard practice in cardiovascular disease prevention, and therapeutic strategies ranging from individuals at high risk (aggressive risk factor management) to those at low risk (periodic monitoring) are relatively straightforward. Further risk stratification appears to carry its greatest benefit for the large segment of the population comprising individuals who are asymptomatic and have "intermediate" risk on the basis of current global risk measures. Noninvasive techniques for assessing vascular wall status or cardiovascular function are useful in some of these individuals because they will enable a more accurate assessment of risk and thereby result in the risk status of the patient being raised to "high."