Heart imaging provides clear information about the state of an individual ,s heart.

I believe that current primary prevention practice has scope for significant reevaluation, particularly in our approach to risk assessment of individuals before they even have a problem. In fact, to me, preventing the chest pain or the heart attack in the first place is the Holy Grail of preventative cardiology.

When discussing risk factor assessment in coronary artery disease, it is extremely important to be clear about the difference between association and causation. Regularly, I need to tell patients that they have cholesterol build-up in their arteries.

Invariably I receive the reply,

• ‘But Doctor, my cholesterol is fine’.

• ‘But Doctor, I exercise regularly’.

• ‘But Doctor, I eat healthy food and keep my weight down’.

• ‘But Doctor, I don’t smoke’.

When we evaluate the risk of an individual in primary prevention of coronary artery disease, we use associations that have been demonstrated in population studies. This presents an inherent problem because risk may be low for the population, but it is 100 percent for the individual who then goes on to have an event. While individual screening using stress-testing does have some merit, it will only identify problems too late in the process of cholesterol build-up in the arteries.

One of the key tools that I use in primary prevention is the latest technology available to scan the heart. Heart imaging provides clear information about the state of an individual’s heart. It is used to inform a management strategy based on exactly what was seen to be happening in the arteries, rather than a best guess based on a populationbased probability of what might be going on.

Cardiac CT imaging will lead to a conclusion that the features observed on the scan are either low, intermediate or high-risk features and this information can then be used against traditional risk variables to facilitate the most accurate computation of an individual patient’s risk. By combining the cardiac CT imaging and risk information of the patient, I believe that the best-informed management strategy for the primary prevention of coronary artery disease in an individual patient, can be achieved.