How to identify the asymptomatic high-risk patient?

Worldwide, cardiovascular diseases are among the leading causes of mortality and morbidity with ever-increasing prevalence. Early targeted initiation of preventive measures would be of great benefit and can provide a major opportunity in reducing mortality and morbidity. To this end, accurate identification of individuals who are still asymptomatic but at elevated risk is essential. However, traditional risk assessment fails to recognize a substantial proportion of patients at high risk while a large proportion of individuals are classified as having intermediate risk, leaving management uncertain. Additional strategies to further refine risk assessment are therefore highly needed. To this end, the use of biomarkers and noninvasive imaging modalities has been proposed. The aim of this review is to provide an overview of the different approaches that are available or under development to improve the identification of asymptomatic individuals at elevated risk for cardiovascular diseases events.