In the Medical Observer’s Clinical Review (August 12) Drs Stephen Fenton and Jason Kaplan explore screening tools and risk factors for early detection of coronary disease in at-risk individuals.

Did you know that about 50% of acute myocardial infarctions (AMIs) occur in people with no known history of symptomatic coronary artery disease (CAD)? Of these 40% will die. And with an AMI occurring every 11 minutes that’s more than three times the number of deaths attributed to the March 2011 Japanese earthquake and tsunami.

It’s well understood from autopsy studies, and more recently by a new intracoronary imaging technique (optical frequency domain imaging) that CAD involves rupture of atherosclerotic plaques covered by a thin fibrous cap (‘vulnerable plaque’) and superimposed thrombus.

However, it is increasingly recognised that the issue is not the ‘vulnerable plaque’ but the ‘vulnerable patient’ – the patient with underlying, undetected and untreated subclinical, asymptomatic atherosclerotic CAD.

These are the patients with a ticking time bomb who often have no idea that they may be at risk.

How can early atherosclerotic disease be diagnosed? The answer is that there have recently been huge advances in this area. Read more about two of these developments – coronary calcium scoring and CT coronary angiography – in the attached clinical review.