The emerging role of coronary computed tomography for prevention of cardiovascular disease in asymptomatic individuals.
Authors
Affiliations (8)
Affiliations (8)
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
- Department of Cardiology, Dupuytren University Hospital, Limoges, France.
- EpiMaCT Research Group, Inserm 1094 & IRD 270, Limoges University, 2, Marcland Ave, 87025 Limoges, France.
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, United Kingdom.
- Department of Radiology, Mayo Clinic Rochester, 200 1st St SW, Rochester, MN 55905, United States.
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1030, New York, NY 10029, United States.
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Abstract
The persistent global rise in atherosclerotic cardiovascular disease (ASCVD) challenges the effectiveness of current risk factor-based algorithms in primary prevention. Most myocardial infarctions occur in individuals without prior symptoms or recognized standard modifiable risk factors, underscoring the need to improve risk stratification. Coronary CT imaging, including coronary artery calcium scoring (CACS) and coronary computed tomography angiography (CCTA), enables direct non-invasive visualization of coronary atherosclerosis, supporting a shift from population-based prevention toward personalized, disease-based risk assessment and targeted preventive treatment. CCTA provides comprehensive evaluation of plaque burden, composition, stenosis severity, and high-risk plaque features, thereby refining risk stratification and guiding personalized treatment decisions. The presence and total burden of coronary atherosclerotic plaque are considered the primary CCTA-derived markers for guiding preventive therapy, while noncalcified plaque burden and high-risk plaque features may support treatment intensification. Advances in CT technology, including photon-counting CT, and the application of artificial intelligence-based tools may further refine risk assessment by enabling accurate and reproducible plaque quantification and characterization. Although no randomized trials have yet demonstrated that CCTA-based screening improves clinical outcomes in asymptomatic individuals compared with standard care, the same is true of traditional cardiovascular risk scores. Three large ongoing randomized trials are currently evaluating whether CCTA-guided, personalized prevention strategies can reduce ASCVD events. The results are eagerly awaited and may redefine the role of CCTA in asymptomatic individuals.