Atherosclerosis evaluation and cardiovascular risk estimation using coronary computed tomography angiography

Clinical risk scores based on traditional risk factors of atherosclerosis correlate imprecisely to an individual's complex pathophysiological predisposition to atherosclerosis and provide limited accuracy for predicting major adverse cardiovascular events (MACE). Over the past two decades, computed tomography scanners and techniques for coronary computed tomography angiography (CCTA) analysis have substantially improved, enabling more precise atherosclerotic plaque quantification and characterization. The accuracy of CCTA for quantifying stenosis and atherosclerosis has been validated in numerous multicentre studies and has shown consistent incremental prognostic value for MACE over the clinical risk spectrum in different populations. Serial CCTA studies have advanced our understanding of vascular biology and atherosclerotic disease progression. The direct disease visualization of CCTA has the potential to be used synergistically with indirect markers of risk to significantly improve prevention of MACE, pending large-scale randomized evaluation. Graphical Abstract Coronary computed tomography angiography (CCTA) can change the population risk-based approach to a personalized care approach and provides important clinical utility. Coronary computed tomography angiography allows for precise atherosclerotic plaque quantification and characterization, and CCTA studies have advanced our understanding of vascular biology that holds potential to change our population risk-based approach to a personalized care approach. Coronary computed tomography angiography also provides clinical utility for assessment of drug efficacy and as a gatekeeper to cardiac catheterization lab. AUC, area under the curve; CAD, coronary artery disease; CCTA, coronary computed tomography angiography; HDL-C, high-density lipoprotein cholesterol.