Assessment for subclinical ischemia: bridging the gap between primary and secondary prevention

The fundamental dilemma of primary prevention of coronary heart disease is that the absolute effectiveness and the cost-effectiveness of strategies to prevent clinical manifestations of disease greatly diminish as the relative risk of cardiovascular events decline in the chosen population. To better target cardiovascular therapies, strategies must be developed to classify individuals in terms of one or more measures of their risk of future cardiovascular events and of their expected responsiveness to the proposed therapy.