ABSTRACT
Cardiovascular disease is the leading cause of death in the USA.1 Each year, approximately 1.1 million individuals experience a myocardial infarction (MI). Approximately 33% of first cardiovascular events are fatal and an additional 33% are a non-fatal MI, survivors of which experience significant morbidity in the form of congestive heart failure, arrhythmias, and an increased risk of sudden cardiac death.1 Thus, primary prevention of cardiovascular events is a healthcare priority, and a major challenge is to identify individuals who would be candidates for more intensive (and therefore more expensive) medical interventions and testing. The Third Adult Treatment Panel of the National Cholesterol Education Program recommended using the Framingham Global Risk Assessment Model to predict coronary heart disease (CHD) risk; however, this model has several limitations when used in clinical practice. For example, this model only predicts short-term (10-year) risk and does not account for family history, ‘predisposing’ risk factors (e.g. obesity, physical inactivity, and socioeconomic status), or ‘conditional’ risk factors (e.g. triglycerides and high-sensitivity C-reactive protein (CRP) levels).2,3 Furthermore, chronological age, a surrogate for plaque burden, is the overriding determinant.4
